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S Kessler

Publications and source records attributed to S Kessler.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Osteomyelitis--imaging methods and their value].

Various imaging modalities are used in diagnosis of acute and chronic infectious endogenous osteomyelitis and exogenous ostitis. The pathophysiological changes of osteomyelitis/ostitis in the bone and surrounding soft tissue are known. Findings in plain film radiography show these changes only in relatively advanced stages of disease. Hence, plain film radiographs are useful as a basic imaging modality by excluding other differentials and as a follow-up modality under therapy. Ultrasound-using advanced technology--offers diagnostic help in acute osteomyelitis, especially in infants. The various techniques of nuclear medicine show much higher sensitivity for detecting osteomyelitis than plain film radiography, but do not permit good separation for bone involvement and infectious changes in the surrounding soft tissue. While computed tomography offers the ability to display bone and soft tissue separately, it has been widely replaced by magnetic resonance imaging using fat-suppressed sequences and paramagnetic contrast media which show the spread of the infectious changes with higher sensitivity and accuracy.

Adolescent↗
PubMed1998

[Spondarthritis hyperostotica pustulo-psoriatica: nosologic study with clinical and radiologic presentation in relation to the SAPHO syndrome].

Spondarthritis hyperostotica pustulo-psoriatica (Spond.hyp.pp-Schilling), corresponding nosologically to pustulotic arthroosteitis, is a dermato-skeletal "double system" disease of adults. It consists of the triad (a) palmo-plantar pustulosis (Ppp) or, alternatively, Königsbeck-Barber-type psoriasis, (b) sternocostoclavicular hyperostosis (SCCH), and (c) truncal-skeletal changes with syndesmophite-like, hyperostotic and/or parasyndesmophite-like ossifications of layers of the anterior vertebral ligament taken together in the sense of a desmophytal hyperostosis. There is also a potential for sclerosing inflammatory arthritis of the sacro-iliac joints and "dry" inflammatory arthritis of peripheral joints. Thus, the pustulo-psoriatic terrain seems to have a decisive influence on osseous pathology. A total of 38 cases from a study during the years 1982 to 1992 is analysed with regard to morphological characteristics. Rare cases with diaphyseal and pelvic hyperostotic lesions subsequent to bland sclerosing osteomyelitis constitute an overlapping region to chronic recurrent multifocal osteomyelitis (CRMO) and illustrate the relationship between hyperostotic spondarthritis and CRMO. The syndromes of "acquired hyperostosis" and "SAPHO", the former more radiologically oriented and the latter more clinically oriented, together with mainly CRMO and hyperostotic spondarthritis and its forms, constitute the "Spond.hyp.pp.". Although hyperostosis is a guidepost for the radiologist and SAPHO symptoms are one for the clinician, the syndrome does not represent a diagnosis by itself and requires further differentiation. In this report the entity "Spond.hyp. pp." is considered and required contributions from rheumatologically and osteologically oriented radiologist.

Acquired Hyperostosis Syndrome↗
PubMed1998

Are the Duke criteria superior to the Beth Israel criteria for the diagnosis of infective endocarditis in children?

Accurate diagnosis of infective endocarditis may be difficult. The Beth Israel criteria and the newer Duke criteria assign probability to the diagnosis of infective endocarditis on the basis of the presence of common features and manifestations. We reviewed 111 cases of pediatric infective endocarditis diagnosed and treated over 19 years. Each case was classified by the two criteria, and the results were compared. Of 111 cases, 73 (66%) and 18 (16%) were classified as definite by the Duke criteria and the Beth Israel criteria, respectively. No cases were rejected by the Duke criteria, while 21 (19%) of 111 were rejected by the Beth Israel criteria. In 18 pathologically proven cases, reanalysis without pathological data showed that the Duke criteria had significantly greater sensitivity (83%) than the Beth Israel criteria (67%) (P < .03). Echocardiographic evidence was required in 22 cases for definite classification by the Duke criteria; none were rejected, however, when echocardiographic findings were ignored. Our results suggest that the Duke criteria are superior to the Beth Israel criteria for the diagnosis of pediatric infective endocarditis.

Adolescent↗
PubMed1998

Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study.

OBJECTIVES: Different prevalences of generalised osteoarthritis (GOA) in patients with knee and hip OA have been reported. The aim of this investigation was to evaluate radiographic and clinical patterns of disease in a hospital based population of patient subgroups with advanced hip and knee OA and to compare the prevalence of GOA in patients with hip or knee OA, taking potential confounding factors into account. METHODS: 420 patients with hip OA and 389 patients with knee OA scheduled for unilateral total joint replacement in four hospitals underwent radiographic analysis of ipsilateral and contralateral hip or knee joint and both hands in addition to a standardised interview and clinical examination. According to the severity of radiographic changes in the contralateral joints (using Kellgren-Lawrence > or = grade 2 as case definition) participants were classified as having either unilateral or bilateral OA. If radiographic changes of two joint groups of the hands (first carpometacarpal joint and proximal/distal interphalangeal joints defined as two separate joint groups) were present, patients were categorised as having GOA. RESULTS: Patients with hip OA were younger (mean age 60.4 years) and less likely to be female (52.4%) than patients with knee OA (66.3 years and 72.5% respectively). Intensity of pain and functional impairment at hospital admission was similar in both groups, while patients with knee OA had a longer symptom duration (median 10 years) compared with patients with hip OA (5 years). In 41.7% of patients with hip OA and 33.4% of patients with knee OA an underlying pathological condition could be observed in the replaced joint, which allowed a classification as secondary OA. Some 82.1% of patients with hip and 87.4% of patients with knee OA had radiographic changes in their contralateral joints (bilateral disease). The prevalence of GOA increased with age and was higher in female patients. GOA was observed more often in patients with knee OA than in patients with hip OA (34.9% versus 19.3%; OR = 2.24; 95% CI: 1.56, 3.21). Adjustment for the different age and sex distribution in both patient groups, however, takes away most of the difference (OR = 1.32; 95% CI: 0.89, 1.96). CONCLUSION: The crude results confirm previous reports as well as the clinical impression of GOA being more prevalent in patients with advanced knee OA than in patients with advanced hip OA. However, these different patterns might be attributed to a large part to a different distribution of age and sex in these hospital based populations.

Age Factors↗
PubMed1997

Psychological aspects of genetic counseling. XI. Nondirectiveness revisited.

Directiveness and nondirectiveness are considered here as psychological phenomena and separated from the issue of giving or withholding advice. The former is a form of persuasive communication involving various combinations of deception, coercion, and threat, whereas the latter describes procedures that promote and enhance the autonomy and self-directedness of clients. Examples are given showing that professionals have considerable difficulty dealing with relatively simple, common issues arising in genetic counseling. It is suggested that many, if not most, problems involving the issue of nondirectiveness arise because of inadequacies in applying basic counseling skills. Several examples are given of nondirective counseling in situations involving direct questions and the proffering of "advice." The need to raise standards in counseling training is underscored if the field of genetic counseling is to remain nondirective.

Genetic Counseling↗
PubMed1997

Benign giant cell tumor of bone with osteosarcomatous transformation ("dedifferentiated" primary malignant GCT): report of two cases.

It is not uncommon for sarcomatous transformation of giant cell tumor (GCT) of bone to occur after radiation, but rarely does malignant transformation occur spontaneously, with less than 15 cases reported up to 1995. Only four of these cases have been documented in detail. We report two additional cases of GCT of bone spontaneously transforming or "dedifferentiating" into osteosarcoma without radiation therapy. The first case is absolutely unique and most interesting in that the dedifferentiation process occurred in one of multiple GCT lung metastases 6 years after successful eradication of a primary tibial tumor. The right lung was resected due to development of a large tumor, and at pathologic examination, demonstrated several small nodules of conventional GCT and a much larger, 14-cm mass composed of a mixture of GCT and high-grade osteosarcoma. The second case involved a physician, who had a large tumor in the sacrum with vague symptoms for 8 years. Open biopsy revealed conventional, benign GCT of bone with a secondary aneurysmal bone cyst. Complete curettage 2 weeks later revealed, in addition to areas of conventional, benign GCT a second component of very high grade osteosarcoma. Both patients died less than 1.5 years from diagnosis. This report of osteosarcomatous transformation of a conventional GCT of bone strengthens the theory that there is a mesenchymal cell line in GCT that may spontaneously transform to sarcoma.

Adult↗
PubMed1997

Assessing health in musculoskeletal disorders--the appropriateness of a German version of the Sickness Impact Profile.

The Sickness Impact Profile (SIP) is gaining increasing popularity in clinical and epidemiological studies, assessing health status or the impact of therapeutic interventions. The SIP was created as a global measure, assessing generic dimensions of health. As there were only a few such methods available in our country, we decided in 1990 to validate a German version of the SIP and to test its appropriateness in patients with musculoskeletal disorders. Due to the up-to-dateness of our results, we decided to publish now the data of this German version of the SIP. Reliability, validity and sensitivity to change of the German version of the SIP were tested in 299 patients with musculoskeletal disorders. The test-retest correlation was high for the overall score (r = 0.81), as well as for Cronbach's alpha (r = 0.83). Results for categories were significantly lower. Validity was tested by comparing the SIP to the Keitel Index (r = 0.6) and to the Measurement of Patient Outcome Scale (r = 0.72), as well as to a control group, which showed significant differences in all categories and in the overall score. Furthermore, the SIP was able to demonstrate therapy-related improvements in health in all our patients. We concluded that the german version of the SIP fulfilled statistical test criteria. The results were comparable to those achieved in the original American version. A cross-cultural comparison using the SIP is justified for at least those patients with musculoskeletal disorders.

Adult↗
PubMed1997

Cartilage viability with interpolated skin flaps: an experimental study.

Although composite cartilage grafts are often used in conjunction with a midline forehead flap to repair full-thickness nasal defects, the timing of pedicle division, which optimizes cartilage viability, has yet to be determined. A rabbit animal model was designed to investigate this question. The skin flap pedicle was divided at 0 days, 4 days, 3 weeks, 6 weeks, and 10 weeks in each of five groups of five animals. Although early pedicle division led to partial skin flap necrosis, the cartilage grafts tolerated this ischemic period better. Cartilage viability was approximately 70% and did not differ significantly between the five groups. It is concluded that a larger composite graft and better definition of the skin flap's critical period are needed to determine optimum timing for pedicle division in this animal model.

Analysis of Variance↗
PubMed1997

Insufficiency and stress fractures of the long bones occurring in patients with rheumatoid arthritis and other inflammatory diseases, with a contribution on the possibilities of computed tomography.

In patients with long standing rheumatoid arthritis and other rheumatoid disorders, stress fractures and insufficiency fractures are not uncommon. The cause may be osteoporosis due to rheumatoid arthritis, corticosteroid therapy, joint stiffness, and deformity of the joints caused by the inflammatory process. Also, unaccustomed exercise after reconstructive joint surgery may be a cause of fractures in these patients. Fractures can be documented on conventional X-ray-pictures and tomograms. Computed tomography can show the medullary extent of these fractures and gives, in several cases, additional information showing the combination of insufficiency fractures with fragmentations of parts of the involved bone. Reconstructive surgery with total joint replacement may be another cause of the development of these fractures. This unaccustomed increase in ambulation may lead to stress fractures in other joints of the same extremity or of contralateral extremity. Pain beginning in joint of the lower extremity in a patient with chronic rheumatoid arthritis should, besides arthritis, raise the possibility of a stress fracture. Also with cases of angular deformity of a joint and unaccustomed exercise after reconstructive surgery patients stress fractures may be seen and can be established by Plainfilm, Computed Tomography scintimetric bone scanning and MRI.

Aged↗
PubMed1996

Exposure of human CD34+ cells to human immunodeficiency virus type 1 does not influence their expansion and proliferation of hematopoietic progenitors in vitro.

The susceptibility of highly purified human CD34+ cells to monocytotropic (Ba-L) and lymphotropic (A018-post) strains of human immunodeficiency virus-1 (HIV-1) was examined. Liquid cultures initiated with fresh immunomagnetically purified CD34+ cells using the K6.1 CD34 monoclonal antibody (MoAb) (K6.1/CD34+) were positive for HIV expression 2 weeks after exposure to HIV-1 Ba-L. These cells were initially greater than 90% CD34+ and had undetectable monocyte contamination by flow-cytometric staining and side-scatter analyses, respectively, and undetectable T-cell contamination by CD3 polymerase chain reaction (PCR) analysis. However, secondary CD34+ liquid cultures reselected from the primary liquid cultures 24 hours after HIV exposure by panning with the ICH3 CD34 MoAb (ICH3/CD34+) and maintained for an additional 14 days were negative for HIV expression. The ICH3-unbound cells were positive for both spliced and unspliced HIV RNA when exposed to HIV-1 Ba-L, and were DNA PCR positive when exposed to either monocytotropic or lymphotropic HIV-1. To further test that CD34+ cells were not infectible by HIV-1, we exposed K6.1/CD34+ cells continuously to HIV-1 in a culture system capable of maintaining and expanding primitive CD34+ cells. HIV-exposed K6.1/CD34+ cells proliferated and expanded as efficiently as uninfected cultures. However, when reselected magnetically using the K6.1 CD34 MoAb after expansion for 7 days, bound K6.1/CD34+ cells were again negative for HIV-1 expression, whereas unbound cells were positive for HIV-1 expression. These findings suggest that a sequential CD34+ cell-selection process, in which the two selections are separated by a brief culture period, can yield a population of CD34+ cells that are not infected with HIV-1. This process may be useful in the design of stem or progenitor cell-based transplantation therapies for HIV infection.

Antigens, CD34↗
PubMed1996

Species variation in the testicular angiotensin converting enzyme promoter studied in transgenic mice.

We have studied the control of transcription of the testicular angiotensin converting enzyme (ACEt) in normal and transgenic mice. Northern analyses, including a developmental curve and separated germ cells, for ACEt mRNA suggest predominantly post-meiotic expression. Mice transgenic for a construct containing the proximal 298 bp of the rabbit ACEt promoter, with chloramphenicol acetyl transferase (CAT) as a recorder, showed correct tissue regulation while a 86 bp fragment of the promoter led to no expression. Many candidate transacting factor binding elements, previously identified as candidate regulators of transcription driving spermatogenesis, are scattered across this 298 bp in the rabbit (but not the mouse) promoter and may lead to tissue specificity. The recent finding that the proximal 91 bp of the mouse ACEt promoter leads to tissue specific expression of a recorder gene (Howard et al., 1993) emphasizes the difference between the two species and the importance of a cAMP response element (CRE) within this fragment for tissue specific expression. This CRE is conserved in the rabbit promoters we used.

Animals↗
PubMed1996

Drug therapy in attention-deficit hyperactivity disorder.

Of 292 patients (210 males and 82 females) receiving medication for attention-deficit hyperactivity disorder (ADHD), 272 (93%) responded well to sustained-release dextroamphetamine (D-Amp) and 21 patients (7%) to sustained-release methylphenidate (MPD). The dose of D-Amp ranged from 0.2 to 3.6 mg/kg/day and the dose of MPD from 1.4 to 7.7 mg/kg/day, without side effects requiring cessation of therapy. This suggests that the clinical improvement rate can be increased to nearly 100% in appropriate situations.

Adolescent↗
PubMed1996

Both the paired domain and homeodomain are required for in vivo function of Drosophila Paired.

Drosophila paired, a homolog of mammalian Pax-3, is key to the coordinated regulation of segment-polarity genes during embryogenesis. The paired gene and its homologs are unusual in encoding proteins with two DNA-binding domains, a paired domain and a homeodomain. We are using an in vivo assay to dissect the functions of the domains of this type of molecule. In particular, we are interested in determining whether one or both DNA-binding activities are required for individual in vivo functions of Paired. We constructed point mutants in each domain designed to disrupt DNA binding and tested the mutants with ectopic expression assays in Drosophila embryos. Mutations in either domain abolished the normal regulation of the target genes engrailed, hedgehog, gooseberry and even-skipped, suggesting that these in vivo functions of Paired require DNA binding through both domains rather than either domain alone. However, when the two mutant proteins were placed in the same embryo, Paired function was restored, indicating that the two DNA-binding activities need not be present in the same molecule. Quantitation of this effect shows that the paired domain mutant has a dominant-negative effect consistent with the observations that Paired protein can bind DNA as a dimer.

Animals↗