Psychosoziale Krankheitsbelastungen und Lebensqualität beim Lymphödem

Obwohl die Erforschung der Lebensqualität in den letzten Jahren zunehmend an Bedeutung gewonnen hat, gibt es bisher kaum Untersuchungen zur Krankheitsbelastung beim chronischen Lymphödem. Die wenigen publizierten Arbeiten betreffen vorwiegend Frauen mit sekundärem Lymphödem nach Brustkrebsbehandlung. Sie zeigen, daß diese Patienten unter zahlreichen funktionellen und psychosozialen Belastungen leiden. Neben der Bewegungsbeeinträchtigung der betroffenen Extremität fällt vielen Frauen vor allem das Annehmen des neuen, disproportionierten Körpers schwer. Verbunden mit Einschränkungen der Arbeits- und Leistungsfähigkeit bedeutet dies für viele Patienten eine Einschränkung ihres Selbstwertgefühls und ihrer Lebensqualität. Weitere Studien mit verbesserten Methoden der Lebensqualitätserfassung sind notwendig, um Patienten mit besonders hohen zu erwartenden Belastungen im Vorfeld zu erkennen und rechtzeitig zu behandeln.

Mutual interference of myotonia and muscular dystrophy in the mouse: a study on ADR-MDX double mutants

For Duchenne muscular dystrophy (DMD, dystrophin deficiency) and Thomsen/Becker myotonia (muscular chloride channel deficiency) genetically homologous mouse models are available, the dystrophin-deficient MDX mouse and the myotonic ADR mouse. Whereas the latter shows more severe symptoms than human myotonia patients, the MDX mouse, in contrast to DMD patients, is only mildly affected. We have introduced, by appropriate breeding, the defect leading to myotonia (Clc1 null mutation, adr allele) into MDX mice, thus creating ADR-MDX double mutants. The expectation was that, due to mechanical stress during myotonic cramps, the ADR status should symptomatically aggravate the muscle fibre necrosis caused by the dystrophin deficiency. The overall symptoms of the double mutants were dominated by myotonia. Weight reduction and premature death rate were higher in ADR-MDX than in ADR mice. Sarcolemmal ruptures as indicated by influx into muscle fibres of serum globulins and injected Evans blue were found with great inter-individual variation in MDX and in ADR-MDX muscles. Affected fibres were found mainly in large groups in MDX but single or in small clusters in ADR-MDX leg muscles. The symptoms of myotonia (aftercontractions, shift towards oxidative fibres) were less pronounced in ADR-MDX than in ADR muscles. Conversely, numbers of damaged fibres as well as the percentage of central nuclei (an indicator of fibre regeneration) were significantly lower in ADR-MDX than in MDX skeletal muscles. Thus it appears that, at the level of the muscle fibre, myotonia and muscular dystrophy attenuate each other.

Cloning and chromosomal mapping of the human p53-related KET gene to chromosome 3q27 and its murine homolog Ket to mouse chromosome 16

KET is a member of the newly discovered family of proteins that is related to the tumor suppressor p53. Here we describe the molecular cloning of a human cDNA of 4846 bp encoding a protein of 680 amino acids. The human KET protein shares 98% identity with the previously characterized rat homolog. The remarkably high degree of conservation lends support to the notion that KET proteins have important basic functions in development and differentiation. Using the GeneBridge 4 radiation hybrid panel, we have mapped KET to human Chromosome (Chr) 3q27. KET is located between the somatostatin gene SST (proximal) and the apolipoprotein D gene APOD (distal) in a region of conserved synteny to mouse Chr 16. This chromosomal region is deleted in early stages of tumorigenesis of mouse islet cell carcinomas and contains the hitherto unidentified Loh2 gene, a putative suppressor of angiogenesis. The murine homolog Ket was mapped in an interspecific backcross panel and falls into this region of loss of heterozygosity. From our mapping data we infer that KET might act as a tumor suppressor and is considered as a candidate for Loh2.

[Coping with illness and quality of life of patients with port-wine stains treated with laser therapy]

Port wine stains (PWS) can lead to considerable emotional distress. The present study evaluated a) the coping with illness, the quality of life and the body image of patients with PWS and b) the effects of dye laser treatment on psychosocial parameters. Seventy PWS patients undergoing treatment with the flashlamp-pumped pulsed dye laser (FPDL) were assessed with questionnaires regarding coping with skin disease, quality of life and body image. Major clinical criterium was the lightening of PWS under treatment. PWS patients showed significant social phobia and avoidance similar to patient suffering from chronic skin diseases. The anxiety correlated with size and darkness of the PWS. In terms of helplessness and depressive mood, PWS patients were less affected than the comparison group. Also, PWS patients had reductions in quality of life and in body image. The coping strategies had a differential effect on the body image. Since there is a correlation between lightening of the PWS and reduction of emotional distress, FDPL therapy can be considered an effective treatment of PWS also in psychosocial terms.

[Melanoma patients: psychosocial stress, coping with illness and social support. A systematic review]

Malignant melanoma (MM) is a cancer with rapidly growing incidence in all age groups and-if not detected early-mostly poor prognosis. After wide excision of the primary tumour, patients without metastases are subjected to follow-up examinations. No further standard medical treatment is currently available for such patients. This results in psychosocial stress, and psychological adjustment and social support are needed-especially in patients with poor prognosis and visible scars. This article reviews recent evidence of the psychosocial correlates in melanoma disease in the context of past research. Factors discussed include psychosocial distress, coping with cancer, support from the social network, and the need for professional psychosocial intervention and its effectiveness. Previous studies which have investigated the correlation between psychosocial factors and the course of the disease are also reviewed. Additionally, suggestions for future research are discussed.

LacZ transgene expression as a cell marker to analyse rescue from the 2-cell block in mouse aggregation chimeras

Embryos from certain mouse strains are arrested at the 2-cell stage in cell culture ('2-cell block'), whereas those from other strains develop to the blastocyst stage under the same conditions. It was previously shown that blocking embryos can be rescued in culture by aggregation with an excess of 2-cell stages of a non-blocking strain such as CBA x C57BL/6 F2. Here we have employed a LacZ transgene in a blocking strain (NMRI) to follow the fate of rescued blastomeres up to the blastocyst stage. We found that rescued blastomeres can participate in both inner cell mass and trophoblast formation, thus completely overcoming the 2-cell block.

Possible role of coagulation factor XIII in the pathogenesis of venous leg ulcers

BACKGROUND

Aim of this placebo-controlled clinical study was to examine the expression pattern of coagulation factor XIIIa in patients with chronic venous leg ulcers and the impact of a 10 day topical factor XIII treatment on ulcer healing, leg ulcer size and radius reduction.

PATIENTS AND METHODS

24 patients were stratified into two groups, each consisting of 12 patients, with leg ulcers > 1.000 mm2, or < 1.000 mm2. Four patients of each study group were assigned to the control group (n = 8). All leg ulcers were treated by topical application of non-adhering dressings and compression therapy. Patients of the treatment group (n = 16) were treated by additional topical treatment off factor XIII twice daily for ten days. Immunohistochemical staining of leg ulcer specimens before and after treatment (day 10) was performed in all patients.

RESULTS

The immunohistochemical staining of factor XIIIa in all specimens before and after therapy showed no significant increase in the expression of factor XIIIa. Comparison of the leg ulcer size, radius and daily radius reduction in the treatment and control group showed no significant differences in values of patients with leg ulcers > 1.000 mm2. However, a decreased leg ulcer size and radius was found in patients of the treatment group with more acute leg ulcers < 1.000 mm2 in contrast to patients with larger leg ulcers (daily ulcer radius reduction from day 0-10; 0.31 mm versus 0.13 mm, p < 0.015).

CONCLUSIONS

These results indicate that locally applied factor XIII promotes especially wound healing of more acute smaller venous leg ulcers. Since immunohistochemical staining of factor XIIIa showed no significant differences before and after therapy, we propose that factor XIII is inactivated rapidly after local application on venous leg ulcers.

[Evaluation of vascular risk factors in patients with Parkinson syndrome]

A vascular etiology of Parkinson's disease (PD) has been long debated. In order to search for an ischemic basis of PD we assessed the clinical symptomatology of a consecutive group of 60 PD patients and compared their frequency of cerebrovascular risk factors, carotid atherosclerosis and ischemic brain lesions with age-matched groups of stroke patients and normals. There were 16 (27%) subjects with PD who also had symptoms of cerebrovascular disease. The frequencies of carotid stenoses, ischemic brain lesions and most of cerebrovascular risk factors seen in the latter group was comparable with those of stroke patients and significantly higher than in the investigational subsets of patients with "pure" PD and normals. Only one (1.6%) individual with PD presented signs suggestive of an ischemic etiology of parkinsonism. These findings suggest that cerebrovascular disease occurs in approximately one fourth of patients with PD, but seldomly is causally related.

Development and validation of a disease-specific questionnaire on the quality of life of patients with chronic venous insufficiency

BACKGROUND

Recording of Quality of Life (QoL) is taking on increasing importance in medicine. Although QoL cannot be measured directly, numerous methods studies have demonstrated that important areas of QoL can be addressed by validated questionnaires. The present study was designed to examine a new disease-specific, German-language questionnaire, the Freiburger Questionnaire of QoL in venous diseases (FLQA), with respect to reliability, validity and patient acceptance-among patients with chronic venous insufficiency (CVI).

PATIENTS AND METHODS

The FLQA consists of 83 items and differentiates between limitations in QoL in 7 scales: physical complaints, everyday life, social life, emotional status, therapy, satisfaction, occupation. Data were collected from 246 patients with CVI stage I (n = 107), II (n = 75) and III (venous ulcer, n = 64) in the Widmer classification.

RESULTS

In the psychometric test, the majority of scales showed little or no top or bottom effect. The internal consistency of the scales was generally high (Cronbach's Alpha in all scales more than alpha = .70 and in 4 scales above alpha = .90). The convergent validity with the Nottingham Health Profile and the ALLTAG was high in several scales. The FLQA showed good discriminant validity and significantly differentiated between the clinical CVI stages in several areas of QoL. The change sensitivity during the course of therapy was also good. In a feasibility test, the acceptance values among patients were high with respect to ease of understanding and description of the QoL areas relevant to them. The mean time to fill out the questionnaire was 21 +/- 6 minutes.

CONCLUSION

Overall, the FLQA appears suitable to reliably record characteristics of QoL in patients with CVI in both course and cross-sectional studies.

Simultaneous bilateral contrast transcranial doppler monitoring in patients with intracardiac and intrapulmonary shunts

The prevalence of a right-to-left intracardiac shunt, demonstrated by echocardiography and transcranial Doppler sonography has been shown to be higher in stroke patients than in normal controls. The aim of this study was to assess the sensitivity and specificity of contrast transcranial Doppler sonography in comparison to transesophageal echocardiography in the detection and differentiation of intracardiac and intrapulmonary shunts and to correlate the transcranial Doppler findings with clinical outcome and morphological findings. Forty five consecutive stroke patients with suspected paradoxical embolism were entered into the study. In all 25 patients with middle cerebral artery stroke of the left (56%) or right (44%) territory and echocardiographic demonstrated patent foramen ovale (80%) or intrapulmonary shunt (20%), simultaneous bilateral transcranial Doppler sonography of the middle cerebral arteries was performed after contrast medium injection during rest and valsalva straining under standardized and optimized conditions. Overall sensitivity for the detection of a right-to-left shunt by contrast transcranial Doppler sonography was 97% and overall specificity was 70%. Bilateral appearance of microbubbles, microbubble count and time delay of microbubble appearance significantly increased after valsalva straining. In patients with intracardiac shunts, a significantly higher microbubble count (32 vs. 13 in patients with an intrapulmonary shunt) and a shorter time interval of microbubble appearance (11 vs. 14 s in patients with intrapulmonary shunts) was observed. There was no correlation between the side and numerical distribution of microbubble count and the location and severity of the current clinical symptoms, as well as between microbubble count and presence and hemispherical distribution of brain infarcts. Transcranial Doppler sonography is a highly sensitive method for the detection of right-to-left shunts, whether of cardiac or pulmonary location. However. no correlation was found between the side and number of microbubbles counted and the clinical symptomatology.

Spinal muscular atrophy gene wobbler of the mouse: evidence from chimeric spinal cord and testis for cell-autonomous function

Human hereditary neurodegenerative diseases are genetically and mechanistically very heterogeneous and so are spinal muscular atrophies and cerebellar ataxias in the mouse, despite the common phenomenon of neuronal death. In this species, a number of mutations impair spermiogenesis in addition to neuron survival. Among these, the wobbler mutation on proximal chromosome 11 of the mouse leads to motoneuron degeneration in brain stem and spinal cord and to a defect of spermiogenesis. Chimeric mice of the type wr?/wr? <--> +/+ were produced, and their allelic status at the wr locus was determined by PCR diagnosis of a closely linked marker. Two overt chimeras, one female (XX <--> XX) and one male (XY <--> XY) were identified as wr/wr <--> +/+ and analyzed with respect to their pathological phenotype. Although there was patchy astrogliosis in the spinal cords of both chimeras, their motor performances were overtly normal and muscles were without signs of denervation. The male's testes revealed a mosaic pattern of normal and pathological spermatids. As no progeny was derived from wr spermatids, the spermatocytes appear as a primary target of the wr mutation in testis. Our results argue against a humoral mechanism of the wobbler disease and indicate a cell-autonomous action of the wr gene both in testis and in spinal cord.

Magnetic resonance imaging cerebral abnormalities and neuropsychologic test performance in elderly hypertensive subjects. A case-control study

OBJECTIVE

To search for a morphologic basis of cognitive impairment possibly associated with arterial hypertension using magnetic resonance imaging and a demanding neuropsychologic test battery.

DESIGN

Case-control comparison with age, length of education, presence of diabetes, and presence of cardiac disease as matching criteria.

SETTING

Austrian Stroke Prevention Study.

SUBJECTS

A total of 89 hypertensive subjects and 89 control subjects from a subset of 272 volunteers with no neurologic symptoms undergoing extensive diagnostic workup in a large-scale stroke prevention study among randomly selected elderly community members.

MAIN OUTCOME MEASURES

Focal brain abnormalities and size of ventricles and cortical sulci as assessed by magnetic resonance imaging and neuropsychological test scores.

RESULTS

Hypertensive subjects more commonly showed areas of white matter hyperintensity and moderately severe ventricular enlargement compared with controls. While no differences were noted between the investigational groups in test results of memory capacity and conceptualization, hypertensive subjects tended to perform worse when assessed for attentional and visuopractical skills. These differences became significant when comparing the brain-damaged subsets of patients and controls with their counterparts without cerebral changes. The pattern and extent of neuropsychologic deficits was similar in hypertensive and normotensive subjects with abnormal magnetic resonance imaging scans.

CONCLUSION

Our data strongly suggest the high rate of brain abnormalities among hypertensive subjects as the cause of their subtle neuropsychological dysfunction.

Neurosonographic findings in dementia

We performed neurosonographic examinations in 19 patients with vascular dementia (VD) and compared these findings with those in 21 patients with dementia of the Alzheimer type (DAT) and in 20 controls. There were no significant differences in age and sex among these three subject groups. The severity of dementia quantified by the Mini-Mental State Examination and Mattis Dementia Rating Scale did not reveal significant differences between VD and DAT. We found that carotid stenosis > 50% or occlusion was more frequent in VD compared to controls. The mean flow velocities of both the middle cerebral artery (MCA) and the basilar artery (BA) were decreased in VD and DAT compared with controls. This decrease was statistically significant for left MCA, but not for right MCA and BA. However, we did not find any significant differences between VD and DAT for the mean flow velocities of both MCA and BA.

Phorbol-12-myristate-13-acetate-treated human keratinocytes express B7-like molecules that serve a costimulatory role in T-cell activation

In previous studies, Phorbol-12-myristate-13-acetate (PMA)-treated human keratinocytes (PMA-HNK) were shown to induce T-cell proliferation via a major histocompatibility complex (MHC)- and antigen (Ag)-independent mechanism, that was mediated in part by PMA-induced intercellular adhesion molecule (ICAM)-1 on HNK. Recently, the interaction of the B7 Ag on antigen-presenting cells with its ligand CD28 on T cells has been shown to deliver activation signals distinct from the interaction of MHC/Ag with the T-cell receptor. These findings led us to assess whether B7-dependent signals play a role in T-cell proliferation induced by PMA-HNK. We first examined B7 expression on HNK by staining with three different monoclonal antibodies (MoAbs). When analyzed by fluorescence-activated cell sorter, untreated HNK stained only faintly. By contrast, PMA induced a dose-dependent upregulation of B7 staining. This staining identifies a molecule closely related to B7 because it was blocked by purified recombinant B7 immunoglobulin. Upregulation of B7 staining was first observed 16 h after PMA treatment and persisted for at least 48 h; it was protein kinase C dependent and required de novo protein synthesis. Anti-B7 MoAbs reduced specifically the capacity of PMA-HNK to trigger proliferation of allogeneic peripheral blood mononuclear cells and T cells. The combination of anti-B7 and anti-ICAM-1 MoAbs further reduced this response. We conclude that PMA upregulates on HNK the expression of a B7-like molecule that contributes in concert with ICAM-1 to the capacity of PMA-HNK to induce proliferation of allogeneic T cells.

Effect of cysteamine on insulin release and exocrine pancreatic secretion in vitro

Cysteamine is known to deplete somatostatin from pancreatic D cells. In the isolated perfused rat pancreas we investigated its effects on somatostatin and insulin release as well as exocrine pancreatic secretion in the presence of 16.7 mM glucose and 180 pM CCK-8. At a concentration of 0.1 mM, cysteamine had no significant effect on pancreatic endocrine and exocrine functions. At 10 mM, however, cysteamine released somatostatin (380 +/- 70 vs 100 +/- 20 fmol/20 min), inhibited insulin output (890 +/- 120 vs 13210 +/- 3260 mu units/20 min) and reduced exocrine pancreatic secretion (volume: 12 +/- 2 vs 20 +/- 2 microliters/20 min; lipase: 31 +/- 3 vs 60 +/- 7 units/20 min). We conclude that the complex changes induced by cysteamine are consistent with a physiological role of endogenous somatostatin in the regulation of insulin release. The reduction of exocrine pancreatic secretion, however, was at least in part, if not completely, mediated via the insuloacinar axis rather than a direct effect of cysteamine-released somatostatin on pancreatic acinar cells.

Plasma renin activity (PRA) and plasma aldosterone in the adrenal cortex hyperactivity. Studies on 50 hypertensive patients

The authors have studied on 50 patients hospitalized in the Adrenal Pathology unit of the Institute of Endocrinology, the etiopathogeny of arterial hypertension (AH) in hypercorticism and the therapeutic implications, arriving at the conclusion that in 20% of the cases AH was probably due to an increased activity of renin-angiotensin and in 47% to elevated levels of aldosterone. The authors hypothesize that AH in the remaining 30% of the hypercorticism cases in this study is due to other mineralocorticoids in excess and suggest that the treatment should be pathogenic and strictly individualized.

Studies of the reproduction function in hyper- and hypoadrenocorticism

The investigation was carried out on 66 patients with hypo- or hyperfunctional syndromes of adrenocorticism, hospitalized and treated by our team. The patients were grouped into 5 lots according to their diseases. Lot one consisted of 34 female patients with Cushing's syndrome, lot two of 10 males with Cushing's syndrome, lot three of 10 males with Addison's disease and lot four, of 6 females with androgenic hypercorticism. The morphofunctional disorders of reproduction were followed up clinically and by complex hormone assays, before and after treatment. The incidence of these disorders is very high, and the results of clinical observations and of laboratory data demonstrate that both the excess of adrenocortical hormones and the decrease in their circulating level have a negative influence on the reproduction function or represent a risk factor in cases of pregnancy. By the curative treatment of the adrenal cortex a preventive treatment of abortion and/or sterility is achieved.

The role of the renin-angiotensin system in arterial hypertension in hypercorticism

The authors have studied on 25 cases of hypercorticism, one of the mechanisms of producing arterial hypertension, the renin-angiotensin system. The study showed that in only 20% of the cases plasma renin activity was high whereas in the remaining 80% other mechanisms were responsible for the hypertension. In the cases in which the plasma activity of renin was high, by studying the changes in the value of electrolytes we were able to derive some understanding of the mechanism of action of the RA2A system. Thus, the literature data show that sometimes the excess of glucocorticoids causes hypertension by activating directly the RA2A system and concomitently inhibiting the renin-kalikrein system (RKKS) and PgS; at other times, the excess of glucocorticoids is exerted on the same renin-angiotensin system, but via ACTH and ADH, the electrolytes values being those that demonstrate the borrowed mechanism.

The dyslipemic syndrome in acromegaly

The clinico-hormonal course of acromegaly and the presence of the hyperlipemic syndrome were studied in relation to age, sex, associated hypothyroidism, diabetes, obesity and cardiovascular and atherosclerotic complications in 43 acromegalic patients (18 males and 25 females) of which 6 had received no treatment and 37 had been submitted 2 - 13 years to conventional roentgentherapy (31 cases), 90Y (5 cases) and hypophysectomy (1 case). Hyperlipemia (HLP), present in 24 acromegalic patients (55.8% of the cases) unrelated to age, was more frequent in women (64% as against 44% in males) and correlated with the clinico-hormonal evolution (GH greater than 20 mg) (60% of the cases), and associated hypothyroidism (79%), obesity (42%) and diabetes (25%). Of the hyperlipemic acromegalic patients, 62% had cardiovascular and atherosclerotic complications. The results of the study point to the need for a hypoglucidic, hypolipidic and associated treatment for hypothyroidism, diabetes and obesity in the prophylaxis of acromegalic atherosclerosis.

Hypercorticism--a risk factor in arterial hypertension and atherosclerosis

The present work has attempted an analysis of the role hypercorticism as a risk factor in arterial hypertension and atherosclerosis. Our series consisted of 149 male and female patients of various ages. The incidence of cardiovascular disorders in relation to age and the glucidic lipidic metabolic disorders were also investigated. The results showed that hypercorticism may trigger in very young patients as well arterial hypertension (AH) and glucidic-lipid metabolic disorders both incriminated as risk factors in including atherosclerosis. Hypercorticism was proved to be an aggravating factor of pre-existing cardiopathy. Efficient management of adrenocortical hormones excess brings complete resolution of arterial hypertension and glucidic lipid metabolic disorders in young patients and most adult patients who had no cardiovascular complaints prior to the endocrine syndrome.