Search PubMed⌕ Search

Biomedical subjects

W H Jost

Publications and source records attributed to W H Jost.

At least 37 records · Page 2Linked to original sources
PubMed2002

Current state of stem cell research for the treatment of Parkinson's disease.

Current findings suggest that multipotent stem cells may be suitable for cell replacement therapies in the treatment of neurodegenerative disorders. Embryonic stem (ES) cells are pluripotent cells isolated from the inner cell mass of the preimplantation blastocyst, which give rise to all cells in the organism. Similarly, multipotent stem cells are also able to regenerate, but are believed to have a more restricted potential than ES cells, and are often defined by the organ from which they are derived. Neural stem cells have been categorized as multipotent stem cells derived from the nervous system with the capacity to regenerate and to give rise to cells belonging to all three cell lineages in the nervous system: neurons, oligodendrocytes, and astrocytes. It is hoped that research on stem cells may reveal methods for producing an infinite supply of dopamine neurons for transplant into Parkinson's disease (PD) patients. The problem is controlling cell growth and differentiation. We will briefly review the current state of stem cell research and will critically discuss the potential of stem cells for the treatment of PD.

Brain Tissue Transplantation↗
PubMed2001

Botulinum toxin: evidence-based medicine criteria in blepharospasm and hemifacial spasm.

Botulinum A toxin is recognized and approved for symptomatic treatment of hemifacial spasm and blepharospasm. The state of trials is good, although double-blind placebo-controlled studies have been carried out involving only a small number of cases. Open case control studies have been done with large patient collectives. In both indications, treatment with botulinum toxin reaches the highest EBM degree in a critical evaluation.

Animals↗
PubMed2001

Evidence-based medicine: botulinum toxin A in migraine and tension-type headache.

The therapeutic effect of botulinum toxin in headache was observed coincidentally. The rationale for this new indication initially met with a great deal of scepticism, because the toxin's mechanism of action, cholinergic chemodenervation, does not fit the pathophysiological concept of migraine and other forms of headache. Meanwhile a fair number of studies have been published which indicate efficacy for botulinum toxin and recommend its use for the treatment of tension headache and migraine. According to the evidence-based medicine criteria, grade I evidence has been demonstrated. In addition the use of botulinum toxin for cluster-headache and secondary headache is discussed. Further large scale studies will be regarded to demonstrate the long-term efficacy.

Animals↗
PubMed2001

Botulinum toxin: evidence-based medicine criteria in rare indications.

Presently, there are more than 50 possible indications for the application of botulinum toxin. In some indications the use of botulinum toxin has already been approved; others are about to be approved. For most of these indications a sufficient number of studies have been published. For rare indications, an insufficient number of studies are available. In part there are only published case reports. Classification according to the criteria of evidence-based medicine is thus difficult. Here we try to describe the range of possible indications for botulinum toxin A and assess its therapeutic value for rare indications. The number of studies available on botulinum toxin B is still limited.

Animals↗
PubMed2001

Penile and perianal pudendal nerve somatosensory evoked potentials in the diagnosis of erectile dysfunction.

Neurophysiologic examinations in differential diagnosis of erectile dysfunction comprise electromyogramme of the pelvic floor, pudendal nerve terminal motor latency (PNTML) and evaluation of pudendal somatosensory evoked potentials (SSEP). We focused our interest on comparing diagnostic importance of penile and perianal pudendal nerve SSEP. We examined 20 patients suffering from erectile dysfunction and 20 patients without any manifestation of impotence. The stimulus was administered using penile ring electrodes at the base of the penis (cathode) and distally on the penis shaft (anode), as well as a perianal surface electrode applied at 3 o'clock in lithotomy position and 5 cm laterally on the gluteal skin. The potentials were recorded with intradermal needle electrodes at C(z)-2 cm (different) and F(z) (indifferent). 500 stimuli were averaged for a single tracing. The stimulus strength was set at an average of 3-4 times the stimulus threshold. Cortical latency of P 40 ranged from 39.0 to 45.6 ms (penile) and from 33.6 to 43.2 ms (perianal) in the control group, in the patient group latencies ranged from 38.8 to 51.6 (penile) and 34.0 to 44.8 ms (perianal). In two patients no potential was recordable after perianal stimulation, one patient showed a marked prolongation of the penile response with a normal perianal latency. Penile and perianal latencies of P 40 were significantly prolonged in the patient group compared to the control group (P<0.05). The combination of penile and perianal pudendal SSEP may provide valuable additional information in differential diagnosis of erectile dysfunction, especially allowing to identify different sites of neurogenic lesions. In contrast to perianal pudendal SSEP, penile stimulation may help to discover pathologic changes in the distal course of the pudendal nerve, especially the dorsal nerve of the penis.

Adult↗
PubMed2000

Intra- and interindividual reproducibility of heart rate variations in the tilt-table test.

Various methods are used for the routine diagnosis of autonomic regulation disorders. The evaluation of blood pressure and heart rate response during active orthostasis together with assessment of the 30/15-ratio (Ewing's ratio) was proven to be a valid method. One main disadvantage of these tests is their dependence on the active cooperation of the patient. In contrast, passive orthostasis using the tilt-table may also be carried out in bed-ridden patients. The test comprises a manual tilting manoeuvre of the patient lying on the tilt-table, with continuous assessment of heart rate and blood pressure. Until now, the main advantages of the tilt-table test were considered to be its better standardisation and good reproducibility, especially with regard to the diagnosis of vasovagal syncope. Several authors have postulated a specific pattern of initial heart rate response in healthy patients, showing characteristic changes in cases of underlying autonomic neuropathy. However, the diagnostic relevance of these tests is dependent on the reproducibility of the course of initial heart rate response. The objective of our study was to assess the intra- and interindividual reproducibility of initial heart rate response in the tilt-table test in healthy subjects. The tilt-table test was repeated 10 times in all 40 subjects under standardised conditions, and heart rate and blood pressure response were presented in a diagram. Reproducible courses of initial heart rate response were not seen, neither on intra- nor on interindividual comparison. After an initial rise, most subjects showed a rather horizontal course of heart rate, whereas others presented a heart rate response similar to that in the Ewing test, with an initial rise of heart rate around the 15th beat, followed by a decrease, and a maximum around the 30th beat. However, all subjects showed considerable variations in heart rate response within the 10 tilting manoeuvres. A reliable quotient comparable with the 30/15 ratio (Ewing's ratio) in active orthostasis was not seen. Based on these results, we conclude that the initial heart rate response in the tilt-table test is not suitable for routine diagnosis of autonomic regulation disorders, since it is not sufficiently reproducible in healthy individuals.

Adolescent↗
PubMed2000

Costs in the treatment of parkinsonism.

Parkinson's disease imposes a considerable economic burden on our society. Apart from the direct costs for therapy, the indirect costs of the disease are estimated to be substantially higher. Unfortunately, only the high costs of current medication are usually considered, when financial aspects are discussed. An ideal therapy should ameliorate the symptoms of the disease and achieve a high quality of life. but the prognosis should also be improved. Cost estimates have to be extended throughout the course of the disease. We recommend a treatment schedule which is expected to result in a favorable cost profile when the entire course of the disease, is considered. L-Dopa monotherapy in working patients is obsolete. During the course of the disease dopamine agonists, amantadine, budipine, COMT inhibitors and selegiline will be used.

Antiparkinson Agents↗
PubMed2000

Workshop III: late motor complications of Parkinson's disease.

The aim in the current treatment of Parkinson's disease is to delay L-Dopa administration and to keep the L-Dopa dosage as low as possible. Such a treatment strategy can delay the onset of late motor complications and reduce their severity. L-Dopa remains the most potent anti-parkinsonian medication, but its use for the initial therapy of Parkinson's disease is limited to elderly patients. In all other cases, dopamine agonists, budipine, amantadine and selegiline are primarily used. With the occurrence of late motor complications continuous dopamine receptor stimulation becomes essential. In this situation, combination therapy has to be individualized, with dopamine agonists playing a key role. In addition, COMT inhibitors, budipine, amantadine and selegiline may be used. Anticholinergic drugs are of very limited importance in the current treatment of Parkinson's disease.

Antiparkinson Agents↗
PubMed1999

[The oral vitamin E tolerance test--an attempt at standardization].

Chronic vitamin E deficiency causes various neurological symptoms such as cerebellar ataxia, hypoesthesia, areflexia, pigmentary retinopathy, nystagmus and muscle weakness. This is commonly caused by malabsorption of vitamin E, which is either a result of malabsorption of fat or occurs as an isolated vitamin E deficiency. The oral vitamin E tolerance test is suitable for the assessment of vitamin E reabsorption and elimination. However, standardised normal parameters have not yet been defined. We investigated 61 healthy individuals aged 18-70 years (mean age, 45.0 years). Each person involved in the trial received 100 IU of all-rac-alpha-tocopherol in 200 millilitres of whole milk. The vitamin E in the serum was then analysed 0, 3, 6, 9, 12, 24, 36, 48, 60, 72 hours after vitamin E was given, using high pressure liquid chromatography. The ratio of vitamin E to the sum of cholesterol and triglycerides was calculated. The 90% CI for the ratio of serum vitamin E to the sum of cholesterol plus triglycerides at the indicated time points was: t = 0 h: 2.0-6.3 micrograms/mg, t = 6 h: 4.2-15.3 micrograms/mg, t = 12 h: 3.0-13.0 micrograms/mg, t = 24 h: 3.8-14.4 micrograms/mg, t = 36 h: 2.9-10.5 micrograms/mg, t = 72 h: 2.1-8.7 micrograms/mg. The serum concentration of vitamin E correlated predominantly with the sum of cholesterol and triglycerides (r = 0.73). The ratio of these parameters is therefore most suitable for diagnosing vitamin E deficiency without relying on false normal serum vitamin E concentrations as a result of abnormally high serum lipid concentrations.

Administration, Oral↗
PubMed1999

Repeat botulin toxin injections in anal fissure: in patients with relapse and after insufficient effect of first treatment.

Botulin toxin (BoTx) injections are an alternative treatment for uncomplicated anal fissures. Until recently, surgical management has been advocated for therapeutic failure of BoTx and recurrent fissures. In 20 patients with recurring anal fissure we examined the remission rate following a second course of botulin treatment. The dose was identical to the first treatment (5 units Botox). In group 2, 30 patients with therapeutic failure were treated with a higher dose of botulin toxin (10 units). In our patients with recurring fissure, 19 of 20 were pain-free within a week (95%). After three months, 14 patients (70%) had healed fissures. In group 2, 22 of 30 patients (73%) became pain-free within the first week following the second course of treatment. Two patients (7%) suffered from transient mild incontinence. Nineteen patients (63%) showed healed fissures three months following the second BoTx treatment. BoTx remains an effective treatment in recurring anal fissure as well as in patients with therapeutic failure of prior BoTx injections.

Adult↗