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Biomedical subjects

W Stremmel

Publications and source records attributed to W Stremmel.

At least 199 records · Page 11Linked to original sources
PubMed1994

[Importance of proximal femoral fractures in elderly patients. Results of a prospective study of 61 patients].

In a prospective study we found good results concerning postoperative complications (21%), perioperative lethality (3.2%) and lethality during hospital stay (6.5%) after implantation of dynamic hip screws (DHS) in patients with per- and subtrochanteric fractures of the femur. The ability to walk, as well as housing and social care postoperatively and follow-up for at least six months after dismissal demonstrates the importance of these fractures for the elderly. One of three patients needs professional care, 21% at home, 13% in nursing homes. Six months after operation the lethality is nearly 20%, i.e. three times higher than in hospital. These are the essential data for all techniques of osteosynthesis used in patients with these fractures, which could only be documented in prospective studies.

Aged↗
PubMed1994

Low vitamin E content in plasma of patients with alcoholic liver disease, hemochromatosis and Wilson's disease.

The RRR-alpha-tocopherol (vitamin E) content in plasma from 46 patients with liver diseases and 23 healthy controls was determined by high performance liquid chromatography and electrochemical detection. Patients were divided into three groups: alcoholic liver diseases (n = 17; group A), hemochromatosis (n = 17; group B) and Wilson's disease (n = 12; group C). Lipid-standardized alpha-tocopherol levels were determined to neutralize differences due to hyperlipemia. The ratio of serum vitamin E to serum lipids (cholesterol, triglycerides, phospholipids) was highest in healthy controls and in patients in group A with cirrhosis and normal transaminases and bilirubin. Patients in group A with acute or chronic ethanol intoxication and high bilirubin levels had a 37% lower lipid-standardized vitamin E level than controls. Patients in group B with hemochromatosis, showing high serum iron (> 180 micrograms/dl), a low free iron binding capacity (< 8 mumol/l) and high ferritin-levels (< 450 micrograms/l), had a 34% lower vitamin E/lipid ratio than healthy controls. No significant lowering of the vitamin E/lipid ratio was observed in the other patients in group B. A significant decrease (37%) in the vitamin E/lipid ratio was only detectable in patients with Wilson's disease (group C) showing high free serum copper (> 10 micrograms/dl). The data support a role for free radicals in the pathogenesis of active liver diseases.

Adult↗
PubMed1993

[How many patients with chronic viral hepatitis qualify for interferon therapy? Prospective analysis of university ambulatory care].

How many patients with chronic viral hepatitis are suitable for interferon therapy? A prospective analysis of a university out-patient department. The present study prospectively analyzes 273 consecutive patients admitted to the outpatient-hepatology clinic for interferon therapy of chronic viral hepatitis from 1989 to 1991. 149/273 (54.6%) patients suffered from hepatitis-B viral infection (HBV). Of the 107 patients with NANB-hepatitis (39.2%) 103 patients finally proved to have hepatitis-C viral infection (HCV) (96.3%). In 17/273 patients (6.2%) the outside diagnosis of viral hepatitis was wrong. The percentage of men versus women was significantly greater in HBV (71.8% vs. 28.2%) than in HCV infection (52.4% vs. 47.5%) (p < 0.01; c2-test). The admittance of patients increased from 68 patients in 1989 to 88 patients in 1990 and 117 patients in 1991. The percentage of HCV-patients increased from 26.4% in 1989 to 38.6% in 1990 and 43.6% in 1991. The number of patients with HCV-infection admitted by non-university hospitals versus practitioners and internists was significantly greater in HCV-infection (48.5% vs. 51.5%) compared to HBV-infection (hospitals: 36.9%; practitioners: 63.1%) (p < 0.05). Interferon therapy was initiated in 131/252 patients (52%) with HBV- or HCV-infection. HCV-patients were treated with interferon significantly more frequently (59.2%) compared with HBV-patients (46.9%) (p = 0.05). Since interferon therapy was initiated in only about 50% of HBV- and HCV-patients, the selection criteria for such treatment need to be publicized more effectively. The marked increase in patients with HCV-infection suggests that recent improvements in serology of viral hepatitis are widely and appropriately used in clinical practice.

Adult↗
PubMed1993

Bilitranslocase and sulfobromophthalein/bilirubin-binding protein are both involved in the hepatic uptake of organic anions.

The hepatic uptake of cholephilic organic anions is a carrier-mediated process. Three distinct proteins [bilitranslocase (BTL), sulfobromophthalein (BSP)/bilirubin-binding protein (BBBP), and organic anion-binding protein] have been isolated from the basolateral plasma-membrane domain of the hepatocyte. To investigate the relative role of the first two of them in accounting for the hepatic uptake of organic anions, we measured the initial rates of uptake of 35S-labeled BSP into rat liver plasma-membrane vesicles. Because transport by BTL is electrogenic but transport by BBBP is electroneutral, studies were done either with or without a positive-inside membrane potential produced by adding valinomycin in the presence of an inwardly directed K+ gradient (outside K+ > inside K+). Both electrogenic and electroneutral transport systems followed saturation kinetics. Electroneutral uptake showed an apparent Km of 20 +/- 3 microM (mean +/- SD) and a Vmax of 1.0 +/- 0.13 nmol.(mg of prot)-1.15 sec-1, whereas the electrogenic portion of BSP uptake exhibited a Km of 5.2 +/- 0.8 microM and a Vmax of 1.1 +/- 0.1 nmol.(mg of prot)-1.15 sec-1. In this case, an overshoot was observed 15 sec after valinomycin addition. Electroneutral BSP uptake was inhibited by incubation with anti-BBBP antibody, whereas anti-BTL antibody did not show any inhibitory effect. Conversely, the electrogenic uptake was inhibited by anti-BTL antibody at a BSP concentration of 5 microM; no inhibition was seen either at 20 microM BSP or upon addition of anti-BBBP antibody. From these data we conclude that the hepatic uptake of organic ions occurs via two immunologically distinct carrier proteins (BTL and BBBP) operating in parallel. BTL is a higher affinity electrogenic transporting system of organic ions, whereas BBBP is a lower affinity electroneutral transporter.

Animals↗
PubMed1993

Relationship between striatal glucose consumption and copper excretion in patients with Wilson's disease treated with D-penicillamine.

In 12 patients with Wilson's disease treated with D-penicillamine (DPA), the regional cerebral metabolic rate of glucose consumption of the lentiform and caudate nucleus was analysed using the 18Fluorodeoxyglucose method and correlated with the clinical symptoms of the patients, the ceruloplasmin level, the serum level of free copper and the 24-h copper excretion. The more copper was eliminated, the higher was the basal ganglia glucose consumption. On the other hand, in seven patients who had been treated for more than 7 years a significant decline of the basal ganglia glucose consumption was observed, suggesting too low a maintenance dose of DPA.

Adolescent↗
PubMed1993

Pathogenesis of genetic haemochromatosis.

Genetic haemochromatosis is an autosomal recessive inherited iron overload disease. The genetic defect and the underlying metabolic error are not known. Several observations indicate that the 2-4-fold increase of iron absorption is due to a regulatory defect of a membrane iron transport system in duodenal mucosal cells. The key pathophysiologic factor may be the increase of gut-derived non-transferrin bound iron liganded to low-molecular mass organic molecules. A putative membrane carrier protein for non-transferrin bound iron was identified and preliminary data suggest its enrichment in plasma membranes of human mucosal cells as well as in liver and other organs which are affected in genetic haemochromatosis. Cellular accumulation of ionic iron leads to peroxidative decomposition of organelle membrane phospholipids with the consequence of cell degeneration and cell death. Impairment of organ function and structural alterations such as cirrhosis of the liver are clinical manifestations.

Ferritins↗
PubMed1993

Motor impairment in Wilson's disease, I: Slowness of voluntary limb movements.

Twenty-three patients with Wilson's disease (WD) treated with D-penicillamine underwent clinical examination, as well as laboratory and motor testing. The clinical findings were scored. Laboratory tests included determination of the caeruloplasmin level, the free serum copper level, 24 h urinary copper excretion, liver enzymes and in 10 patients liver copper content of a liver biopsy. Laboratory tests and clinical scores were correlated. To quantify impairment of voluntary movements in WD fastest possible isometric index finger extensions and fastest alternating finger movements were analysed. Eleven patients presented with abnormally slow and 15 with abnormally irregular voluntary movements. Slowness of alternating movements correlated with the clinical score. The clinical score also correlated with the duration of symptoms prior to onset of therapy. Motor testing turned out to be sensitive enough to monitor improvement of neurological symptoms after onset of therapy. Comparison with motor testing in other basal ganglia diseases and cerebellar patients showed differences to patients with Parkinson's and Huntington's disease and similarities to patients suffering from AIDS-related dementia. In a small number of WD-patients similar results as in patients with a degenerative cerebellar disease were found.

Adolescent↗
PubMed1993

Motor impairment in Wilson's disease, II: Slowness of speech.

The maximal syllable production rate (MSPR) and the ability to reproduce a given target frequency in the 1 to 8 Hz range by repeating the short syllable "ta" was tested in 20 patients with Wilson's disease (WD) and 20 normal subjects. MSPR was significantly reduced in the WD-patients. In the 1 to 5 Hz range normal subjects as well as WD-patients tended to produce slightly higher frequencies than the target frequencies. This hastening was maximal in normals between 4 to 5 Hz whereas in the WD-patients hastening mainly occurred between 3 to 4 Hz. The test results showed a considerable variation across the patients. This variation can be interpreted on the basis of the theory of coupled oscillators. Comparison of speech and finger movements revealed a highly significant correlation between MSPR and the highest possible frequency of voluntary alternating index finger movements. As an application of the presented test treatment effects on speech movements were demonstrated.

Adolescent↗
PubMed1992

[Diagnosis and therapy of hepatorenal syndrome].

Hepatorenal syndrome (HRS) is defined as severe vasoconstriction of renal cortical vessels with critical impairment of glomerular filtration rate, initiated by deteriorating liver function. In addition, systemic vasodilation, predominantly of splanchnic vessels is present. Although the urinary status is basically normal, during the course of HRS kidneys are loosing their ability to concentrate and at an urinary production rate of less than 100 ml/day the urinary osmolarity and Na(+)-concentration drops significantly. Because HRS can not be improved by conventional medical treatment regimens, its prophylaxis is of major importance. Besides improvement of liver function and avoidance of drastic volume depletion (bleeding, paracentesis, high dose diuretic therapy) and sepsis, the therapeutic goal is to reverse systemic vasodilation and to achieve a concomitant relaxation of renal arteries. Expansion of plasma volume and application of renal vessel dilating prostaglandins is one strategy. Alternatively, therapy with ornipressin was shown to be successful, which improves renal perfusion and normalizes the hyperdynamic state of systemic circulation.

Algorithms↗
PubMed1992

Identification and characterization of a monoclonal antibody to the membrane fatty acid binding protein.

A monoclonal antibody to the rat liver membrane fatty acid binding protein (MFABP) was prepared by immunizing mice with purified MFABP isolated from solubilized rat liver plasma membrane proteins by oleate-agarose affinity chromatography technique. The monoclonal antibody K15/6 identified a single 40 kDa protein in rat liver plasma membranes with pI values of 8.5, 8.8 and 9.0, which is identical to the authentic MFABP, but clearly distinct from rat mitochondrial GOT. The antibody K15/6 selectively inhibited cellular influx as well as membrane binding of fatty acids, but not of cholesterol or vitamin E. The same antibody was used in immunofluorescence, ELISA and Western blot analysis to determine the subcellular and organ distribution pattern of MFABP. The protein was identified in rat liver plasma membranes and mitochondria, but in no other cell compartment. It was detectable in homogenates of rat liver but not in homogenates of other organs. Therefore, the monoclonal antibody K15/6 represents an organ specific antibody to MFABP which reveals inhibitory action on membrane binding/transport of fatty acids.

Animals↗
PubMed1992

Testosterone treatment of men with idiopathic hemochromatosis.

Patients with chronic liver disease usually exhibit low plasma levels of testosterone with loss of libido and potency; this is also valid in male patients suffering from idiopathic hemochromatosis (IHC), in whom nowadays the diagnosis is made at an earlier age. Therefore, the effect of testosterone treatment was studied in 10 patients with IHC. After the application of 250 mg testosterone enanthate i.m., the plasma testosterone (from 2.4 +/- 1.9 to 20.1 +/- 7.4 ng/ml) and estradiol (from 17.4 +/- 6.3 to 38.5 +/- 14.2 pg/ml) levels increased significantly. The rise of estradiol was in the range of controls and smaller than reported in other chronic liver diseases. In a long-term study, 250 mg testosterone enanthate was given 4-weekly for 33-96 months to 5 patients with IHC. General well-being, libido, and potency recovered almost immediately. Over a treatment period of 27.3 patient years, symptoms of hyperestrogenism (gynecomastia) or (portal vein) thrombosis were not seen, both of which had been described in patients with alcoholic liver cirrhosis. There was no deterioration of liver function. The effect of testosterone treatment on the patients' well-being and plasma hormone concentrations remained unchanged over the whole period of testosterone treatment. Thus, in male patients with IHC and lowered plasma testosterone, treatment with testosterone enanthate may be instituted. Because of the positive effects on general well-being, liver regeneration capacity, and potency, testosterone should especially be administered to younger subjects suffering from IHC.

Adult↗