Crescentic glomerulonephritis and malignancy--guilty or guilt by association?
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Aged↗
Biomedical subjects
Wolfgang Schneider
Publications and source records attributed to Wolfgang Schneider.
The protean face of sarcoidosis revisited.
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Female↗
Ductoscopy and intraductal vacuum assisted biopsy in women with pathologic nipple discharge.
BACKGROUND: Fiberoptic ductoscopy is increasingly used to evaluate pathologic nipple discharge. A major limitation of this technique is the inability to obtain tissue samples from suspicious intraductal lesions. We present a novel technique for ductoscopic biopsy of intraluminal tumors. METHODS: From 2002 to 2005 ductoscopy was performed in 38 women with nipple discharge using a rigid gradient index microendoscope (diameter 0.7 mm) and a special needle for intraductal vacuum assisted biopsy. Results of preoperative biopsy were correlated with the histology of the resection specimen RESULTS: Cannulation of the discharging duct was successful in 37 of 38 patients (97%). Intraductal lesions were diagnosed in 29 women (78%). The sensitivity of ductoscopy and galactography in the detection of intraductal lesion was comparable (96% vs. 89%). Ductoscopic biopsy of intraductal lesions was technically successful in all but one case. Generally, the quality of the biopsy samples was good. Diagnostic biopsy samples were obtained in 26 of 28 patients (93%). Two samples contained necrosis and were considered to be non-representative. Histological analysis of the biopsy specimens showed 22 papilloma, 2 in situ carcinoma and 2 invasive carcinoma. Histology of the resection specimens confirmed the diagnosis in all cases, but there was one case with additional carcinoma lobulare in situ. CONCLUSIONS: Ductoscopic vacuum assisted biopsy is a new technique for tissue sampling of intraductal breast lesions. This method may improve preoperative evaluation of pathologic nipple discharge in selected patients, but it should not be considered as a method for screening of early breast cancer.
Adult↗
Extramedullary multiple myeloma associated with amyloidomas of the lower limbs.
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Adult↗
Extramedullary multiple myeloma associated with amyloidomas of the lower limbs.
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Adult↗
Frequency, clinical and demographic correlates of pathological dissociation in Europe.
Although pathological dissociation (PD) has received increasing scientific attention in Anglo-American countries, European research on the frequency, clinical and demographic correlates of this discontinuous construct are lacking. An 8-item subscale of the Dissociative Experiences Scale, called the DES-Taxon, was administered to five samples comprising a non-clinical population, students, unselected psychiatric inpatients, eating-disordered inpatients and psychosomatic outpatients with a total of 1,759 adult participants. In the two non-clinical samples, the frequency of PD ranged between 0.3 and 1.8%. Its prevalence was highest in the psychiatric inpatients (5.4%) followed by the eating disorders (4.8%) and the psychosomatic outpatients (2.2%). PD was seen in all diagnostic groups and it was associated with more psychopathological distress and younger age. PD is frequently found in clinical populations in European countries, too. However, methodological problems relating to its empirical determination might obscure the clinical and scientific value of the construct.
Adolescent↗
Requirement of nuclear factor-kappaB in angiotensin II- and isoproterenol-induced cardiac hypertrophy in vivo.
BACKGROUND: In vitro experiments have proposed a role of nuclear factor-kappaB (NF-kappaB), a transcription factor, in cardiomyocyte hypertrophy and protection against apoptosis. Currently, the net effect on cardiac remodeling in vivo under common stress stimuli is unclear. METHODS AND RESULTS: We have generated mice with cardiomyocyte-restricted expression of the NF-kappaB super-repressor IkappaBalphaDeltaN (DeltaN(MHC)) using the Cre/lox technique. DeltaN(MHC) mice displayed an attenuated hypertrophic response compared with control mice on infusion of angiotensin II (Ang II) or isoproterenol by micro-osmotic pumps, as determined by echocardiography (left ventricular wall dimensions: control plus Ang II, x1.5+/-0.1 versus sham; DeltaN(MHC) plus Ang II, x1.1+/-0.1 versus sham; P<0.05; n> or =9), heart weight, and histological analysis. Real-time reverse-transcriptase polymerase chain reaction showed significantly reduced expression of hypertrophy markers beta-myosin heavy chain and atrial natriuretic peptide in Ang II-treated DeltaN(MHC) mice (P<0.05 versus control plus Ang II; n=4). Neither cardiomyocyte apoptosis nor left ventricular dilatation was observed. In cultured adult rat cardiomyocytes, NF-kappaB DNA binding activity was increased by both Ang II- and interleukin-6-related cytokines. The latter are known to be released by cardiac fibroblasts on Ang II stimulation and thus could locally increase the NF-kappaB response of cardiomyocytes. Finally, results from in vitro and in vivo experiments suggest a role for NF-kappaB in the regulation of prohypertrophic interleukin-6 receptor gp130 on mRNA levels. CONCLUSIONS: These results indicate that targeted inhibition of NF-kappaB in cardiomyocytes in vivo is sufficient to impair Ang II- and isoproterenol-induced hypertrophy without increasing the susceptibility to apoptosis.
Angiotensin II↗
Agonistic autoantibodies to the AT1 receptor in a transgenic rat model of preeclampsia.
We used rats transgenic for the human angiotensinogen (hAogen) gene and the human renin (hRen) gene and crossed the strains to produce a model of preeclampsia in the dams. The female (n=9) hAogen x male hRen cross had severe (telemetry-measured) hypertension and albuminuria, which developed during the last trimester of pregnancy and subsided after delivery. The converse cross (n=9) and control (n=9) SD rats did not. We demonstrated that the female hAogen x male hRen cross had agonistic antibodies capable of activating the angiotensin (Ang) II AT1 receptor (AT1R-AA) and defined the epitope on the receptor's second extracellular loop. The phenomenon also occurs in humans with preeclampsia. The rats displayed renal histology reminiscent of preeclampsia, including fibrin deposition confined to the glomeruli. The complement system was activated in glomeruli and IgG deposits were present that may represent AT1R-AA. Finally, we observed an atherosis-like lesion in the spiral arteries of the placental bed, which we called placental-bed arteriolosclerosis. Our model may be relevant to preeclampsia in humans.
Angiotensinogen↗
Bone marrow edema syndrome of the femoral head: treatment with the prostacyclin analogue iloprost vs. core decompression: an MRI-controlled study.
BACKGROUND: The purpose of this study was to assess the efficacy of the vasoactive drug iloprost in Bone Marrow Edema Syndrome (BMES) and to compare it to the results of a control group treated by core decompression. PATIENTS AND METHODS: 38 hips (36 patients) with BMES in the femoral head were investigated. In group A, 18 hips (17 patients; mean age 49 years) were treated with iloprost, a vasoactive drug that dilates arterioles and venules, reduces capillary permeability and suppresses platelet aggregation. The therapy comprised a series of five infusions with 20 microg iloprost over 6 hours on 5 consecutive days. Weight bearing was reduced for up to 3 weeks, depending on the severity of symptoms. In group B, 20 hips (19 patients; mean age 41 years) underwent surgical core decompression of the femoral head followed by 6 weeks of partial weight bearing. Both groups were evaluated clinically, radiographically and by MRI. RESULTS: In group A, one patient had to discontinue therapy on the first day because of severe headache. In the remaining patients the Harris Hip Score (HHS) improved from a mean of 64.7 points (range 44-89) before therapy to 97.0 points (83-100) after 3 months. MRI controls showed complete remission in all hips. In group B, the preoperative HHS improved from 53.7 points (31-82) to 95.1 points (39-100) after 3 months. MRI controls showed complete remission of BMES in 14 hips, residual focal bone marrow edema in four hips and a small osteonecrotic area in two hips. In both groups the high level of clinical recovery was maintained at the last examination after a mean follow up of 11 months in group A and 12 months in group B. CONCLUSION: The parenteral application of iloprost can achieve equal or better results in the treatment of bone marrow edema syndrome of the hip compared to core decompression.
Adult↗
The strategic regulation of children's memory performance and suggestibility.
We report two empirical studies that investigated previously reported benefits of a high accuracy motivation, and thus a high threshold, for children's and adults' event recall and for their ability to resist false suggestions. In the studies, 6-, 7-, and 8-year-olds, as well as adults, were shown a brief video about an event and were later asked unbiased and misleading questions about it. In Study 1, participants were either (a) given the typical accuracy instructions (including the option to answer with "I don't know"), (b) reminded of the accuracy instructions during the interview, or (c) immediately given feedback and a token for every correct answer. The results showed that the reminders were ineffective in stimulating strategic control behavior in children, independent of age. In Study 2, the confounding effects of feedback and incentives were disentangled by contrasting (a) free report, (b) feedback only, (c) incentives only, and (d) feedback plus incentives. Analyses on recall performance and suggestibility revealed that both feedback and incentives are necessary to increase children's accurate memory reports.
Child↗
Lumpy jaw revisited.
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Actinomycosis, Cervicofacial↗
Comparison of fingertip to arterial blood samples at rest and during exercise.
OBJECTIVE: The purpose was to determine whether arterialized fingertip blood-gas samples are comparable to arterial samples at rest and at exercise. DESIGN: Repeated measures, with subjects serving as their own controls. SETTING: Department of Anesthesia, Montreal General Hospital, Montreal, Quebec, Canada, (January to April 2004). PARTICIPANTS: Fifteen healthy men (age = 25 +/- 4 y; weight = 76.4 +/- 11.4 kg; height = 180.7 +/- 8.0 cm; peak oxygen uptake or VO2peak = 46.0 +/- 9.0 mL . kg . min). MAIN OUTCOME MEASURES: Arterial blood gases, metabolites, electrolytes. RESULTS: Blood sampled simultaneously from the radial artery and warmed fingertip at rest and during 2 levels of exercise (vigorous 181 W or 70% VO2peak; maximal 261 W or 100% VO2peak) on a electronically braked ergometer. Arterial partial pressure of oxygen in blood combining rest and the 2 exercise levels was on average 13.6 +/- 9.0 mm Hg higher than arterialized fingertip samples, with the largest difference occurring at rest (18.8 +/- 6.5 mm Hg; 95% CI = 15.5, 22.1) and the smallest difference occurring at the highest level of exercise (8.3 +/- 9.2 mm Hg; 95% CI = 3.6, 13.0; P < 0.05). The pattern for oxyhemoglobin saturation was the same, showing statistical differences between the sampling sites with the differences reduced at the highest exercise intensity. In contrast, there was no difference in arterial and arterialized partial pressure of carbon dioxide in blood (-1.0 +/- 1.5 mm Hg; 95% CI = -1.4, -0.6), or plasma lactate, glucose, pH, hemoglobin, and electrolytes between both sampling sites at rest or at the 2 exercise levels. CONCLUSION: Arterialized fingertip blood samples at rest and during exercise can predict arterial carbon dioxide pressure, and can predict arterial plasma lactate, glucose, pH, hemoglobin, and electrolytes; but not arterial oxyhemoglobin saturation or arterial oxygen pressure.
Adult↗
Donor-site morbidity of the pedicled rectus femoris muscle flap.
The rectus femoris muscle flap is well known for its reliable anatomy, the ease with which it can be harvested, and its great versatility. As a pedicled or free flap, it is used to cover soft-tissue defects and to recreate motor function. Although the muscle is very reliable, it is not well respected because of its assumed donor-site morbidity, such as weakened knee extension force and decreased range of motion of the knee. To date, these clinical assumptions have only rarely been quantified in terms of objective scores, concerning force deficit and functional or aesthetic outcome. From 1995 to 2002, the authors treated 24 patients with pedicled rectus femoris muscle flaps. Fourteen patients were followed up. Follow-up time ranged from 3 to 56 months postoperatively. The results were evaluated by a standard questionnaire in which pain in relation to walking distance, subjective feeling of weakness, sensibility disorders, everyday function, and aesthetic aspects were assessed. Range of motion in the hip and the knee was measured. For objective verification of a decrease of maximal voluntary contraction force of the remaining quadriceps muscle and for detecting differences in true muscular capacity and voluntary activation, 10 patients with unilateral rectus femoris flaps were tested using the twitch interpolation technique. The authors' patients assessed the remaining function and the aesthetic result of the thigh as at least satisfactory. Two patients complained about pain and weakness in the thigh. Eight patients reported hypesthesia in the lateral suprapatellar region. The maximal voluntary contraction and true muscular capacity values were reduced by 21.8 percent and 18 percent, respectively, when compared with the healthy leg. The range of motion in the knee and hip was not influenced by muscle harvesting. The twitch interpolation technique revealed a mild voluntary activation deficit, probably caused by inhibitory regulation in the spinal cord. In conclusion, donor-site morbidity of the rectus femoris muscle flap is evident but well compensated. There is no decrease in active range of motion in the knee and hip. Patient satisfaction with the functional and aesthetic outcome was high.
Adult↗
Lectin-like oxidized low-density lipoprotein (LDL) receptor (LOX-1)-mediated pathway and vascular oxidative injury in older-age rat renal transplants.
BACKGROUND: Older-age renal allografts are associated with inferior survival; however, the mechanisms are unclear. Reactive oxygen species participate in aging and in chronic vascular disease. We investigated how mediators of oxidative stress may increase allograft susceptibility to vascular injury. METHODS: We employed the low-responder allogeneic F344-to-Lew rat renal transplantation model. We used nonimmunosuppressed young (donors and recipients aged 12 weeks), old (donors and recipients aged 52 weeks), and old-to-young animal (donors aged 52 weeks and recipients aged 12 weeks) combinations. Grafts were transplanted after 2 hours cold preservation in University of Wisconsin solution and harvested 1, 2, 7 and 10 days later. Additionally, old animals receiving continuous 1.5 mg/kg cyclosporine (CyA) immunosuppression were included. Renal allograft pathology was scored according to Banff criteria. We studied intragraft vascular adhesion molecule-1 (VCAM-1), lectin-like oxidized low-density lipoprotein (LDL) receptor-1 (LOX-1), and hypochlorite-modified LDL expression as well as ED-1+ monocytes/macrophages and CD8+ lymphocyte infiltration. Intragraft in situ superoxide anion radical production was determined with dihydroethidium assay on cryosections. RESULTS: During the first 2 posttransplant days, old transplants demonstrated higher functional impairment and increased oxidative stress, while young transplant had higher ED-1+ monocytes/macrophage infiltration and VCAM-1 expression. The degree of VCAM-1 expression and ED-1+ monocytes/macrophage and CD8+ lymphocyte infiltration correlated at later time points directly with the transplant age. VCAM-1 and LOX-1 staining were localized predominantly on the endothelium of arterial vessels, shifting the distribution to vascular smooth muscle layer strongly dependent on donor age and the grade of vascular injury. LOX-1 staining colocalized with hypochlorite-modified epitopes in the media of injured arteries. We measured increased in situ superoxide anion radical production in corresponding areas. Immunosuppression with CyA had no protective effect on vascular injury and LOX-1 expression. CONCLUSION: Induction of LOX-1-related oxidation pathways and increased susceptibility to oxidative stress could play an important role in promoting vascular injury in old renal transplants independent of the recipient age.
Aging↗
Poor agreement between prospective and retrospective assessment of hallux surgery using the AOFAS Hallux Scale.
BACKGROUND: Retrospective assessment of preoperative status is common in nonprospective study designs. The aim of this study was to test the hypothesis that prospective and retrospective evaluations of the preoperative patient condition in hallux surgery gives equal results and therefore can be used interchangeably. METHODS: One hundred and fifty-nine consecutive feet with hallux surgery were analyzed prospectively. Parallel to routine evaluation of the preoperative status, the AOFAS Hallux Scale was recorded prospectively. Two years after surgery, the medical records were re-evaluated for retrospective reconstruction of the AOFAS score. Simultaneously all patients were asked to assess their preoperative status retrospectively. RESULTS: Using the medical charts for retrospective assessments, the preoperative status was estimated too low compared to prospective evaluation. This effect was even more pronounced with the patients' own retrospective assessment of their preoperative status. Linear regression coefficient for prospective and retrospective data showed moderate correlation with r = 0.59 for the AOFAS Score using the medical charts and poor correlation of r = 0.24 using the patients' own retrospective assessments. Spearman's rank correlation index was p = 0.57 and p = 0.23, respectively. The coefficient of repeatability according to Bland and Altman was 25.7 and 48.7 points, respectively, for the AOFAS score. The difference between the mean values of prospective and retrospective assessment was 5.6 (13.0) points. This means that a retrospectively evaluated AOFAS Score may be 31.3 points below or 20.1 points above prospective assessments (61.6 points below or 35.7 points above compared to the patients' own retrospective self-assessments). Agreement between individual items using Kappa statistics showed poor results except for metatarsophalangeal joint motion. CONCLUSIONS: Prospectively and retrospectively evaluated AOFAS scores cannot be used interchangeably for clinical outcome evaluations. Retrospective scoring gives worse results even when evaluated using conscientiously recorded medical charts and therefore leads to overestimation of the effect of surgery. These data support prospective study designs to ensure the best outcome analysis for clinical evaluation of hallux surgery.
Female↗
[Operationalized psychodynamic diagnostic (OPD)--potential for quality assurance].
OBJECTIVES: Psychotherapy is subjected to the legal conditions of quality assurance(QA). Does operationalized psychodynamic diagnostics (OPD) contribute substantially to this? METHODS: We investigated the application of OPD in outpatient psychodynamic psychotherapy, inpatient treatment, rehabilitation, and legal assessment. RESULTS: Psychodynamic diagnostics, treatment plan, and evaluation by means of the OPD and Heidelberg Structural Change Scale (HSCS) may be comprehensibly described for quality assurance (QA) of outpatient and inpatient psychotherapy. Virtually all psychodynamic conceptualized departments for psychosomatic medicine and psychotherapy as well as some rehabilitation centres applied OPD. Furthermore, data-collection periods were defined during and after inpatient short- and long-term psychotherapy. OPD serves QA in legal assessment and is of a pivotal significance in judicial proceedings. CONCLUSIONS: It must be deliberated whether more extensive use of QA, in cooperation with outpatient psychotherapists and in comparison to institutions, could be of benefit to patients.
Ambulatory Care↗