Biomedical subjects
Publications and source records attributed to R Kellner.
There are controversies in the literature about the diagnosis and most appropriate treatment of hypochondriasis. The author offers guidelines for diagnosis of hypochondriacal syndromes that have not been adequately dealt with in the literature and discusses the choice of treatments.
In simple epithelial cells, apical and basolateral proteins are sorted into separate vesicular carriers before delivery to the appropriate plasma membrane domains. To dissect the putative sorting machinery, we have solubilized Golgi-derived transport vesicles with the detergent CHAPS and shown that an apical marker, influenza haemagglutinin (HA), formed a large complex together with several integral membrane proteins. Remarkably, a similar set of CHAPS-insoluble proteins was found after solubilization of a total cellular membrane fraction. This allowed the cloning of a cDNA encoding one protein of this complex, VIP21 (Vesicular Integral-membrane Protein of 21 kD). The transiently expressed protein appeared on the Golgi-apparatus, the plasma membrane and vesicular structures. We propose that VIP21 is a component of the molecular machinery of vesicular transport.
In order to examine the relationship of self-rated inhibited anger to somatization, the authors administered several self-rating scales, including the SCL-90 and a Likert scale pertaining to inhibited anger, to psychiatric patients and family practice patients of both sexes. In a linear stepwise regression, depression predicted inhibited anger in all four groups. Previous studies have reported an association of inhibited anger and somatization; the present study suggests that depression is the link between the two in the majority of patients. The relationship of inhibited anger to depression may have implications for psychotherapy.
OBJECTIVE: The purpose of this study was to examine the effects of one session of instructions on the frequency of chronic nightmares and on self-rated distress. METHOD: Twenty-eight volunteers with chronic nightmares (mean duration = 19 years) were treated with either one session of desensitization with instructions on how to practice this treatment or with one session of instructions to change the nightmare and how to rehearse the new version. The authors administered four scales of the SCL-90 and the corresponding scales of the Symptom Questionnaire. RESULTS: At 7-month follow-up of 23 patients, there was a significant reduction in the frequency of nightmares and significant decreases in self-rated depression, anxiety, and hostility. There were no significant differences between the effects of the two types of treatment. In four patients, whose mean duration of nightmares was 23 years, the nightmares ceased. CONCLUSIONS: The results of this preliminary study suggests that the instructions given to the patients reduced the frequency of their chronic nightmares and decreased their self-rated distress.
Four self-rating scales of hypochondriasis and the Symptom Checklist-90 were administered to 100 general practice (GP) patients and matched non-psychotic psychiatric out-patients. In a stepwise linear regression, self-rated somatic symptoms and anxiety predicted hypochondriacal fears and beliefs; self-rated depression did not appear as a predictor. There were differences between males and females and between psychiatric patients and GP patients in the associations of these constructs. These results varied in part with the scale of hypochondriasis used. Various scales of hypochondriasis appear to measure different features of the hypochondriasis syndrome. Fear of disease (disease phobia) was associated with anxiety, whereas a false belief of having a disease (disease conviction) was associated more with somatic symptoms.
A peptide with the same retention time on gradient reversed-phase high-performance liquid chromatography was present in the corpora cardiaca of 5 scarabaeid beetles, subfamily Cetoniinae: the three fruit beetle species Pachnoda marginata, P. sinuata and P. aemulae and the two protea beetle species Trichostetha fascularis and T. albopicta. Crude corpora cardiaca material from P. sinuata had a small hypertrehalosaemic effect in American cockroaches and a very weak hyperlipaemic activity in migratory locusts. Injections into P. sinuata caused hypertrehalosaemia when a dose of 1.0 corpora cardiaca equivalents was injected. An identical neuropeptide was isolated, by RP-HPLC, and sequenced by pulsed-liquid phase sequencing employing Edman chemistry after enzymically deblocking the N-terminal 5-oxopyrrolidine-2-carboxylic acid residue, as well as by collision-induced decomposition tandem fast atom bombardment mass spectrometry. The peptide is a blocked octapeptide: Glu-Leu-Asn-Tyr-Ser-Pro-Asp-TrpNH2, previously designated Mem-CC. The synthetic peptide is able to elicit haemolymph carbohydrates in P. sinuata upon injection of low doses. Activity studies using synthetic analogues of this peptide revealed that Tyr4 may be important for receptor recognition/binding. The peptide is synthesized in intrinsic cells of the corpus cardiacum as shown by in vitro incorporation of [3H]Trp and [14C]Tyr in Mem-CC.
OBJECTIVE: To review the published studies on the sex distribution of hypochondriasis, and to examine sex differences in hypochondriacal concerns and in attitudes toward illness. METHOD: The Illness Attitude Scales, Factors 2 and 3 of the Whiteley Index and the Symptom Checklist-90 (SCL-90) were administered to fifty randomly-selected female family practice patients ages eighteen to sixty-five, and to male patients matched by age in decades. From a pool of 130 consecutive nonpsychotic psychiatric outpatients, fifty females and fifty males were matched with the family practice patients. RESULTS: Although females rated themselves as more depressed than males in both groups, there were no significant differences between the sexes in hypochondriacal fears and beliefs. Psychiatric male patients reported the most adverse effects of bodily symptoms on work and leisure. There were no other significant differences between the sexes in any of the other attitudes toward illness or symptoms. Hypochondriacal concerns were more common in the psychiatric patients than in the family practice patients of both sexes. CONCLUSION: The review of published studies on the sex distribution of hypochondriasis suggests that disease phobia is more common in females, except for the cardiophobic syndrome, which is more common in males. The other reported differences are inconsistent and appear to be caused by referral biases, varying diagnostic criteria, and cultural factors. In our study, we found no substantial differences between males and females in hypochondriacal concerns and attitudes toward illness.
Twenty subjects with chronic nightmares for 17.2 years mean duration were randomly divided into two groups: Rehearsal and Recording. At inception, subjects in both groups were instructed to write down their nightmares for one month. The Recording group received no other intervention. Rehearsal subjects received a single treatment group session teaching an imagery rehearsal technique to reduce nightmare frequency. At inception and three months follow-up, both groups were compared for nightmare frequency and for self-rated distress with scales (Symptom Checklist and Symptom Questionnaire) measuring anxiety, depression, hostility, somatization and total distress. Nightmare frequency decreased significantly in both groups: Rehearsal group-7.2 per month to 2.0 per month (72% reduction) (p < 0.006); Recording group-9.4 per month to 5.0 per month (47% reduction) (p < 0.02). There were no statistically significant differences in the nightmare frequency reductions between groups. All anxiety, depression, somatization, hostility and total distress scores decreased substantially in the Rehearsal group. Most changes were significant. Changes in the Recording group were inconsistent and not significant. Two brief case histories are presented.
OBJECTIVE: The aim of this paper was to review the clinical and conceptual implications of the studies investigating prodromal symptoms of mania, depression, and panic disorder. METHOD: Twenty-four studies specifically addressing the issue of prodromal symptoms in mood and anxiety disorders were selected by computer search (Medline) and manual search of Index Medicus and the psychiatric literature. RESULTS: Most of the studies have described a prodromal phase in the development of mania, depression, and panic attacks. CONCLUSIONS: The appearance of prodromal symptoms may precede the full syndrome by weeks or months; if these symptoms are detected, recurrences of affective disorders (bipolar illness, unipolar depression, panic disorder) could be treated earlier and perhaps more effectively. DSM-III has emphasized the traditional clinical syndromes and cross-sectional descriptions. Appraisal of prodromal and residual phases may complement this approach. The longitudinal study of prodromes, the fully developed disorder, and residual states calls for an assessment of personality, neurotic traits, and their interaction in the evolution of affective disorders.
The following definition of somatization was adopted for purposes of this review. Somatization indicates one or more physical complaints where either appropriate evaluation discovers no organic pathology (or pathophysiological mechanism) or--when there is related organic pathology--the physical complaints or resulting social or occupational impairment is grossly in excess of what would be expected from the physical findings. Conclusions from the main research on somatization are summarized. A large proportion of patients seeking medical care suffer from one of the various forms of somatization. Various etiological factors contribute to somatization and these vary from one person to another. Although there is evidence that treatment is effective, only a small proportion of patients receive appropriate treatment.
The principles of measuring anxiety are reviewed. Scales of anxiety differ in their time focus: state-anxiety scales measure the present or recent past, whereas trait-anxiety scales measure the ways the subject generally feels. Commonly used scales have adequate validity, but there is incomplete agreement on the boundaries of the construct of anxiety. There are consistent differences in sensitivity among anxiety scales, and they vary greatly in the number of items, number of cues and in the method of scoring. For self-rating scales a large number of items with only two cues (e.g. 'yes' and 'no'), or only two scores for each item, increases the sensitivity of the scale for screening as well as for detecting differences between drug and placebo. A large number of cues decreases the sensitivity of a self-rating scale; it is unknown whether a large number of cues is advantageous in group research, but a small number of items is adequate both for rating and self-rating scales.
The squalene-hopene cyclase from Bacillus acidocaldarius cytoplasmic membrane, was purified to homogeneity by solubilization with Triton X-100, chromatography on DEAE-cellulose, phenyl Sepharose and two gel-filtration columns. The enzyme monomer had a molecular mass of 75 kDa. The sequence of the first 23 amino acids was determined by Edman degradation. The enzyme activity was efficiently inhibited by n-alkyldimethylammonium halides with alkyl chain lengths between 12 and 18 C atoms. Inhibition was also observed with (5-hydroxycarvacryl)trimethylammonium chloride 1-piperidine carboxylate, dodecyldimethylamine N-oxide, azasqualene and farnesol. Competitive inhibition with dodecyltrimethylammonium bromide, (5-hydroxycarvacryl)trimethylammonium chloride 1-piperidine carboxylate and dodecyldimethylamine N-oxide was demonstrated by Lineweaver-Burk plots.
A hypertrehalosaemic neuropeptide from the corpora cardiaca of the blowfly Phormia terraenovae has been isolated by reversed-phase h.p.l.c., and its primary structure was determined by pulsed-liquid phase sequencing employing Edman chemistry after enzymically deblocking the N-terminal pyroglutamate residue. The C-terminus was also blocked, as indicated by the lack of digestion when the peptide was incubated with carboxypeptidase A. The octapeptide has the sequence pGlu-Leu-Thr-Phe-Ser-Pro-Asp-Trp-NH2 and is clearly defined as a novel member of the RPCH/AKH (red-pigment-concentrating hormone/adipokinetic hormone) family of peptides. It is the first charged member of this family to be found. The synthetic peptide causes an increase in the haemolymph carbohydrate concentration in a dose-dependent fashion in blowflies and therefore is named 'Phormia terraenovae hypertrehalosaemic hormone' (Pht-HrTH). In addition, receptors in the fat-body of the American cockroach (Periplaneta americana) recognize the peptide, resulting in carbohydrate elevation in the blood. However, fat-body receptors of the migratory locust (Locusta migratoria) do not recognize this charged molecule, and thus no lipid mobilization is observed in this species.
The production of the lanthionine-containing polypeptide antibiotics gallidermin from Staphylococcus gallinarum TU 3928 and pep 5 from S. epidermidis 5 is investigated with respect to regulation and stimulation of productivity by media components, optimization of both the media used and the fermentation process and is compared to the production of the lantibiotic epidermin from S. epidermidis TU 3298. Efficient methods for rapid quantification of lantibiotics, optimization of the media and a primary enrichment by adsorption chromatography are reported.
The testing of a SCN- dose (32 mg NaSCN/kg oral 21 d long) which is about 100 fold above the alimentary SCN(-)-uptake on guinea pig has shown neither histologic/morphometrical nor clinical clue to thyrostatic effect. In 6 regions of the GDR (1,349 persons) has not been secured epidemiologically any relationship between SCN- serum level as well as SCN- urine level and goiter. The partly in the tendency low increase of SCN- level by patients with bland goiter was always under the levels of smokers without goiter, exceeded indeed the threshold of significance in the area of Werdau. In the industrial agglomeration areas the I(-)-SCN(-)-quotient at the most unfavourable cases ran to 3.5 (Halle, smoker, struma), was consequently close to the critical level of the goiter risk.
The presence of clothing for infants does not reflect in quality and quantity the actual situation of medical knowledge. Economical conditions are not responsible for that fact, but especially uninformation of industry and physicians, too. Our contribution should inform doctors, especially from child welfare centres, about clothing to infants. Recommendations were given to a more proper clothing of infants.
The author lists the main theories of somatization and some of the pertinent empirical studies. The studies suggest that there is no single theory that can adequately explain somatization, which is not only multifactorially determined but is an exceedingly complex phenomenon. There is consistent empirical support for some of the theories, such as somatization being a function of depression or of anxiety, and little or inconsistent research support for some other theories, such as its being a symbolic method of communication or an attempt at conflict resolution. The contributions of the various etiological factors differ from one individual to the next, and it requires sometimes lengthy exploration before the extent of the various contributions can be gleaned.
A wobbled 14-mer oligonucleotide was derived from the amino acid sequence of the 34-residue propeptide of the lantibiotic Pep5 (Kellner et al. 1989). Using this hybridization probe, the structural gene of Pep5, pepA, was located on the 18.6 kbp plasmid pED503. The nucleotide sequence of pepA codes for a prepeptide with 60 residues and proves that Pep5 is ribosomally synthesized. The N-terminus of the prepeptide has a high alpha-helix probability and a characteristic proteolytic cleavage site precedes the C-terminal 34-residue propeptide. Our present theory is that maturation of Pep5 involves (a) enzymic conversion of Thr, Ser and Cys into dehydrated amino acids and sulfide bridges, (b) membrane translocation and cleavage of the modified prepeptide.