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Biomedical subjects

S Zierz

Publications and source records attributed to S Zierz.

At least 55 records · Page 3Linked to original sources
PubMed2001

Hearing impairment is common in various phenotypes of the mitochondrial DNA A3243G mutation.

OBJECTIVE: To determine whether there are common symptoms within different phenotypes of the mitochondrial DNA A3243G mutation. DESIGN: A series of 52 adults with mitochondrial encephalomyopathies and their symptomatic relatives were screened for the A3243G mutation using restriction enzyme analysis. In addition to clinical examination, patients with the mutation underwent audiometry. RESULTS: The A3243G mutation was identified in 16 patients (10 index patients and 6 symptomatic relatives). Six of these patients presented with strokelike episodes and met the classical criteria of MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes), and one had MELAS/MERRF (myoclonic epilepsy with ragged-red fibers) overlap syndrome. Two patients presented with strokelike episodes but did not meet the classical criteria of MELAS. Predominant features of the 8 other patients were myopathy with hearing loss and diabetes mellitus (n = 1), chronic progressive external ophthalmoplegia (n = 1), diabetes mellitus with hearing loss (n = 1), painful muscle stiffness with hearing loss (n = 1), cardiomyopathy (n = 1), diabetes mellitus (n = 1), and hearing loss (n = 2). In 11 of 16 patients, hearing impairment was obvious on clinical examination. Furthermore, all 5 patients with normal hearing on clinical examination showed subclinical hearing loss; in 4, hearing loss was more pronounced than age-related hearing impairment and in 1, hearing loss can be age related as well. CONCLUSIONS: A variety of phenotypes represent the variable multisystemic involvement of the A3243G mutation. Less than half of the patients presented with MELAS. Hearing impairment, the most common symptom, was clinically or subclinically relevant in 15 (94%) of 16 patients.

Adolescent↗
PubMed2001

GCG repeats and phenotype in oculopharyngeal muscular dystrophy.

Short GCG repeat expansions in the PABP2 gene were recently shown to cause oculopharyngeal muscular dystrophy (OPMD) in French-Canadian and Italian pedigrees. We diagnosed OPMD in 16 German patients by the detection of GCG repeat expansions, confirming genetic homogeneity. Myopathic and neurogenic changes were found in skeletal muscle biopsies. Age of onset and severity of disease were not correlated with the number of repeats.

Age of Onset↗
PubMed2001

Discharge patterns of spontaneous activity and motor units on concentric needle electromyography.

We analyzed discharge patterns in electromyograms of 6 patients with complete nerve lesions and of 26 healthy subjects, in order to better differentiate between pathological and physiological spontaneous electromyographic (EMG) activity. Within 1639 trains of action potentials, the intervals between at least five successive discharges were measured. Discharge regularity was evaluated with three different algorithms. At 99% specificity, an abnormal discharge pattern was identified with 91 to 95% sensitivity, depending on the algorithm used. Analysis of as few as four successive interdischarge intervals allowed reliable differentiation between normal and pathological spontaneous EMG activity.

Action Potentials↗
PubMed2001

Length dependence of variables associated with temporal dispersion in human motor nerves.

Temporal dispersion in motor nerves is associated with changes of amplitude, area, duration, and Fourier spectra of compound muscle action potentials (CMAPs) when comparing responses to proximal and distal stimulation. These changes depend on the length of the nerve segment. To quantitatively assess this dependence, motor conduction studies of nerve segments of various lengths were performed in the median, ulnar, and tibial nerves of 86 test subjects, aged 4 to 73 years. Amplitude, area, duration, and spectral energy above 49 Hz of CMAPs were measured. Values after distal and proximal stimulation of each nerve segment were compared to determine amplitude decay, area decay, protraction, and high-frequency attenuation. A significant length dependence of amplitude decay was found in the tibial and ulnar nerves, of area decay in the median and ulnar nerves, and of CMAP duration in the ulnar and tibial nerves. The length dependence of the high-frequency attenuation was significant in all nerves studied. This report provides normative data for variables associated with temporal dispersion.

Action Potentials↗
PubMed2001

[Familial mitochondrial chronic progressive external ophthalmoplegia. Five families with differing genetics].

UNLABELLED: Chronic progressive external ophthalmoplegia (CPEO) is considered the most frequent form of mitochondrial encephalomyopathies. Most cases occur sporadically. We investigated 18 consecutive patients with CPEO. Thirteen cases were sporadic and five cases were familial. In one family with maternal inheritance the mitochondrial point mutation A3243G was identified. In index patients of three other families multiple deletions of mitochondrial DNA were found. One of these families showed autosomal recessive inheritance. In the two other pedigrees a definitive determination of the mode of inheritance was impossible. The fifth family revealed autosomal dominant or maternal inheritance. In their index patient no alteration of mitochondrial DNA could be identified (including sequencing of hot spots for mitochondrial mutations). CONCLUSIONS: CPEO was familial in 28% of our patients. There are three different modes of inheritance: (i) maternal transmission associated with mitochondrial point mutations as it is known for other mitochondrial disorders, (ii) autosomal recessive, and (iii) autosomal dominant inheritance. In contrast to sporadic cases with single mitochondrial deletions autosomal inheritance can be associated with multiple deletions of mitochondrial DNA. They are due to so far unknown nuclear mutations.

Adult↗
PubMed2001

Different sensitivity of rabbit heart and skeletal muscle to endotoxin-induced impairment of mitochondrial function.

The involvement of mitochondrial dysfunction in septic disturbances of tissues is controversial. The aim of this study was to investigate the effects of endotoxin-induced sepsis on the function of heart and skeletal muscle mitochondria. Rabbits were made septic by subcutaneous injection of endotoxin (lipopolysaccharide, LPS) from Escherichia coli at concentrations of 100 or 150 microg LPS.kg(-1) 24 h prior to the experiments. Mitochondrial respiration was measured in saponin-skinned muscle fibers and compared with photometrically detected activities of respiratory chain enzymes as well as with function of perfused hearts. In heart fibers a dosage of 100 microg LPS.kg(-1) caused a significant decrease of state 3-respiration for the substrates pyruvate (-38%), octanoyl-carnitine (-38%) and succinate (-30%) with correspondingly decreased respiratory control indexes (RCI). In addition, endotoxin caused a decreased temporal stability of the rate of state 3-respiration. At least in part these changes can be attributed to a reduced activity of complex I + III (-50%) of the respiratory chain. State 4-respiration rates were not significantly altered. The lowered state 3-respiration in heart mitochondria seems to contribute to the impairment of heart muscle function as detected by an increase of coronary vascular resistance (CVR) in endotoxin-treated hearts. Functional properties of mitochondria from M. Vastus lasteralis were not affected by 100 microg LPS.kg(-1) but a higher dosage of 150 microg LPS.kg(-1) caused decreased RCI for the substrates pyruvate (-29%) and octanoyl-carnitine (-32%). Also the activity of complex I + III was not significantly affected at lower dose of endotoxin but decreased (-42%) after treatment with 150 microg LPS.kg(-1). Results demonstrate the involvement of impaired mitochondria in the pathophysiology of septic organ failure and a tissue specificity of endotoxaemia.

Animals↗
PubMed2001

Doppler microembolic signals in patients with two different types of bileaflet valves.

OBJECTIVES: This study was performed to evaluate the prevalence and counts of Doppler microembolic signals in patients with St Jude Medical valves (St Jude Medical, Inc, St Paul, Minn) and patients with ATS valves (ATS Medical, Inc, Minneapolis, Minn) and their relation to clinical parameters. METHODS: A total of 179 outpatients of the department of cardiothoracic surgery were examined. They included 98 men and 81 women, aged 61 +/- 11 years, with ATS (n = 91) or St Jude Medical (n = 88) valves in the aortic (n = 110), mitral (n = 39), or both positions (n = 30). Neurologic examination was followed by transcranial Doppler monitoring for microembolic signals. Monitoring was performed bilaterally over the middle cerebral arteries for 1 hour per session. RESULTS: Microembolic signal counts and prevalence were significantly higher in patients with St Jude Medical as compared with ATS valves. Valve type and presence of diabetes mellitus were the only predictors of microembolic signal prevalence on multivariate analysis. No influence of microembolic signals on cerebral embolic complications was established. Additionally, patients with a postoperative history of cerebral embolic complications did not have a higher number of microembolic signals than remaining patients. Interobserver variability was satisfactory. CONCLUSIONS: Patients with St Jude Medical valves were shown to have significantly higher microembolic signal counts than patients with ATS valves. However, our results suggest that microembolic signal counts cannot be used to predict cerebral embolic complications. Their relation to neuropsychologic deficits remains to be evaluated.

Aged↗
PubMed2000

Relation between maximum discharge rates on electromyography and motor unit number estimates.

To improve quantitative assessment of motor unit recruitment by standard concentric needle electromyography (CNEMG), hypothenar muscles of 22 healthy subjects, 18 with denervation, and 10 with a myopathy were studied. Discharge rates of motor units were measured in CNEMG recordings comprising action potentials of, at most, 4 motor units. Motor unit number estimation (MUNE) was done using the manual incremental method. In controls, the upper 95% limit of the discharge rate was 16.2/s. In all subjects, a strong nonlinear correlation between the number of motor units and the maximal discharge rate was found (r = 0.88, P < 0.0001). Increased discharge rates were found in all but one of the paretic muscles with denervation, but in none of the myopathic muscles. Measurement of the discharge rate is a simple and reliable procedure. If the discharge rate is high in a hypothenar muscle, loss of motor units can be inferred. Moreover, the discharge rate value gives an estimate of the number of motor units in that muscle. Thus, we suggest that maximal discharge rate be included in electromyographic reports.

Action Potentials↗
PubMed2000

Higher proportion of mitochondrial A3243G mutation in blood than in skeletal muscle in a patient with cardiomyopathy and hearing loss.

Phenotypes of individuals with the mitochondrial A3243G mutation and amount of mutant DNA in different tissues can be very variable, but the proportion of mutant DNA was consistantly lower in blood than muscle in previously studied patients. We detected the A3243G mutation in a 54-year-old patient with cardiomyopathy and hearing loss, where the amount of mutant DNA was higher in blood (19%) than in muscle (6%). This shows that the level of A3243G mutation is not always lower in rapidly dividing tissues such as blood than in muscle, as has been presumed until now.

Cardiomyopathy, Hypertrophic↗
PubMed2000

Predictive value of S-100beta and neuron-specific enolase serum levels for adverse neurologic outcome after cardiac surgery.

OBJECTIVES: The aim of this study was to evaluate the time course of S-100beta and neuron-specific enolase serum levels after cardiac surgery and their clinical relevance in predicting postoperative adverse neurologic outcomes; the 2 proteins are only released in peripheral blood in association with nervous system lesions. METHODS: We neurologically assessed 190 consecutive patients undergoing elective cardiac operations for coronary artery bypass (n = 147), valve replacement (n = 29), or both (n = 14), before as well as after the operation. Postoperative outcome was classified as type I (uncomplicated), type II (confusion, agitation, disorientation, or epileptic seizures), or type III (stroke, stupor, or coma). Levels of S-100beta and neuron-specific enolase were evaluated in venous blood samples drawn preoperatively and then daily in the first 5 postoperative days. RESULTS: Levels of S-100beta and neuron-specific enolase differed significantly among the 3 groups (type III > type II > type I) throughout the postoperative period and had a diagnostic specificity and specificity of 89% and 79%, respectively, in identifying patients with type III outcome. S-100beta (but not neuron-specific enolase) levels were identified as significant independent predictors for type II and III outcomes (odds ratio 16.2, P <.0004). The same was true for duration of cardiopulmonary bypass (odds ratio 1.02, P <.006). CONCLUSIONS: Serum levels of S-100beta are reliable markers for adverse neurologic outcomes after cardiac surgery.

Biomarkers↗
PubMed2000

Differentiation between true microembolic signals and artefacts using an arbitrary sample volume.

We evaluated a new discrimination technique between microemboli (MES) and artefact signals. Monitoring was performed over the middle cerebral artery (55 mm) and the brain parenchyma (29 mm). Intensity changes were expressed as percent of change compared to the value measured in the proximal depth. The cut-off value providing the highest sensitivity and specificity in the differentiation was evaluated using 250 MES and 250 artefact signals, and subsequently analysed in the first part of the study. Intensity values derived from the distal depth were subsequently evaluated in 10 patients undergoing cardiac surgery and 45 patients with potential arterial or cardioembolic source. Intensity changes of 87% (84%-90%) and -58% (-71%-(-48%)) were measured in the initial 500 signals for MES and artefact signals, respectively. The best intensity cut-off value was calculated at 27%. This value was subsequently applied to a total of 1858 MES and 1958 artefacts, resulting to sensitivity and specificity of 96% and 98%, respectively. The proposed technique provided adequate results, warranting further evaluation.

Artifacts↗
PubMed2000

A family with PROMM not linked to the recently mapped PROMM locus DM2.

Proximal myotonic myopathy is an autosomal dominantly inherited multisystem disorder, clinically similar to but genetically distinct from myotonic dystrophy (DM). A recently mapped second locus for myotonic dystrophy was thought to be an attractive candidate locus for PROMM, and this hypothesis was supported by reports of linkage to this locus in some PROMM families. We present a large German pedigree with PROMM in which linkage to this locus could be excluded, showing that PROMM is genetically heterogeneous.

Adult↗
PubMed2000

Function of the mitochondrial outer membrane as a diffusion barrier in health and diseases.

The mitochondrial outer membrane separates the intermembrane space from the cytosol. The whole exchange of metabolites, cations and information between mitochondria and the cell occurs through the outer membrane. Experimental evidence is reviewed supporting the hypothesis of dynamic ADP compartmentation within the intermembrane space. The outer membrane creates a diffusion barrier for small molecules (adenine nucleotides, creatine phosphate, creatine etc.) causing rate-dependent concentration gradients as a prerequisite for the action of ADP shuttles via creatine kinases or adenylate kinases. If the outer membrane becomes leaky, cytochrome c and apoptosis-inducing factor can be released, leading to apoptosis, and as a bioenergetic consequence the cytosolic phosphorylation potential decreases. Leaky outer membranes can be detected in saponin-skinned fibres with spectrophotometric and oxygraphic methods. This is of special interest in respect to acute impairment of mitochondria during ischaemia/reperfusion.

Adenosine Diphosphate↗
PubMed2000

Cerebrovascular reactivity is impaired in patients with cardiac failure.

AIMS: We undertook this study to evaluate potential changes in cerebral vasoreactivity in patients with cardiac failure and their consequent dependence upon cardiac functional variables. METHODS AND RESULTS: A total of 50 patients with various degrees of heart failure, 20 age-matched controls and 20 normal controls were examined. Cerebrovascular reactivity was examined with the carbon dioxide technique. Mean flow velocities of both middle cerebral arteries as well as end-tidal carbon dioxide partial pressure were continuously registered. Normal controls were examined on two different occasions, to evaluate the technique's reproducibility. Cerebrovascular reactivity was significantly reduced in all examined patients as compared to controls, and in NYHA IV as compared to NYHA II and III patients. A significant relationship between cerebrovascular reactivity and left ventricular ejection fraction was evident. Reproducibility of the technique was satisfactory. CONCLUSION: Our study provided evidence of significantly reduced cerebrovascular reactivity in patients with cardiac failure, which was significantly related to the NYHA grade and the left ventricular ejection fraction.

Blood Flow Velocity↗
PubMed2000

[Bilateral inferior hemianopsia as an early symptom of Heidenhain type Creutzfeldt-Jakob disease].

BACKGROUND: The Heidenhain variant is a subtype of Creutzfeldt-Jakob disease (CJD) where visual symptoms are leading. HISTORY AND SIGNS: We report on a 60-year-old woman who developed within a few weeks bilateral inferior hemianopsia. Morphological findings of the eyes were normal. Neurological examination and cerebral CT/MRI were normal too. P 100 latency of visual evoked potentials (VEP) of both eyes, however, was delayed. OUTCOME: During the course of the disease visual field narrowed progressively and 3 months after the first symptoms the patient went blind. Only at that time myoclonia, hyperkinesia, and psychiatric symptoms appeared. Changes of EEG and cerebrospinal fluid were suggestive of Creutzfeldt-Jakob disease (CJD). The patient died after 5 1/2 months and diagnosis was confirmed neuropathologically with mainly occipital spongiform encephalopathy. CONCLUSION: This case illustrates the diagnostic difficulties of the Heidenhain type of CJD and demonstrates that in patients with progressive visual field defects without morphological abnormalities of the eyes or radiological abnormalities of the brain CJD should be considered. It should be looked out for additional neurological (especially extrapyramidal) and psychiatric symptoms.

Creutzfeldt-Jakob Syndrome↗