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  • Bone marrow transplantation  (4)
  • Intensive care unit  (3)
  • Demyelination  (2)
  • 1
    Digitale Medien
    Digitale Medien
    Influence of human cytomegalovirus on immune reconstitution after bone marrow transplantation (1992)
    Springer
    Annals of hematology 64 (1992), S. A140 
    Details
    ISSN: 1432-0584
    Schlagwort(e): Cytomegalovirus infection ; Bone marrow transplantation ; Graft-versus-host disease
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary HCMV infection diagnosed by the highly sensitive polymerase chain reaction (PCR) technology in blood, urine and skin biopsies of patients after bone marrow transplantation (BMT) correlated with the reconstitution of peripheral blood lymphocytes and dermal immunohistological alterations to evaluate the interaction of viral infection with the recovery of the immune system, as well as with the induction or aggravation of graftversus-host disease (GVHD). In a prospective study 73% of 63 patients showed viremia at a median time of 25 days after BMT. Only 44% of these cases that also presented with a higher frequency of acute GVHD symptoms developed HCMB disease later on. In the skin, similar immunohistological alternations, as well as frequent primary local HCMV infection before the development of cutaneous signs of GVHD, was found, suggesting the direct involvement of anti-HCMV immune responses in the induction of GVHD-associated organ lesions.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01715368
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  • 2
    Digitale Medien
    Digitale Medien
    Knochenmarktransplantation bei akuter Leukämie, chronisch myeloischer Leukämie, schwerer aplastischer Anämie und Neuroblastom Stadium IV. Einfluß antiviraler Prophylaxe mit Anti-CMV-Hyperimmunglobulin und Azyklovir (1986)
    Springer
    Journal of molecular medicine 64 (1986), S. 452-466 
    Details
    ISSN: 1432-1440
    Schlagwort(e): Bone marrow transplantation ; Anti-CMV hypergammaglobulin ; Azyklovir ; Conditioning
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Bone marrow transplantation was performed between IV/82 and X/85 in 64 patients with acute leukemia (n=36), chronic myelogenous leukemia (CML;n=13), severe aplastic anemia (n=12), and neuroblastoma stage IV (n=3). Of these patients 57 received allogeneic marrow from HLA-ABCDR identical, MLC-negative sibling donors. Six transplants were performed with syngenic marrow and one with autologous marrow. Of the 64 patients 48 survived 40-1,250 days after transplantation, resulting in a survival rate (SR) of 75% and a survival probability (SP) of 71%. Of the 36 patients suffering from acute leukemia (SR=64%, SP=51%), patients with acute myelogenous leukemia (AML) in first complete remission (n=11; SR=81%, SP=76%), as well as patients with acute lymphatic leukemia (ALL) in 1st to 4th complete remission at the time of transplantation (n=14; SR=81%, SP=76%) show a favorable prognosis. A poor survival rate was seen for patients with AML when transplanted in second or partial remission (1/5; SR=20%), as well as for patients suffering from ALL and transplanted during relapse or partial remission (1/6; SR=16%). Of 13 patients suffering from CML 12 survived the transplantation free of relapse (SR=93%, SP=92%), and one patient died from varicella zoster pneumonia. Of the transplanted patients with severe aplastic anemia, 12 of 13 are surviving with complete hematologic reconstitution; one patient, however, died on day 10 from a sepsis. In our patient group, the SR as well as the SP has been improved through changes in the irradiation protocol concomitant with prophylactic application of anti-CMV hypergammaglobulin, as well as through additional oral medication of Azyklovir. The 41 patients (BMT No. 7–47) with total body irradiation at one time-show an SR of 44% and an SP of 41%. The following 46 patients (BMT No. 48–93) have reached an SR of 83% and an SP of 74% under the regimen of fractionated total body irradiation, plus prophylaxis with anti-CMV hypergammaglobulin and Azyklovir. Within this group, no fatal CMV pneumonia was encountered as opposed to six patients lost from CMV pneumonia in the first group.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01713171
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  • 3
    Digitale Medien
    Digitale Medien
    Immunohistological skin alterations in allogeneic bone marrow transplantation (1984)
    Springer
    Journal of molecular medicine 62 (1984), S. 675-688 
    Details
    ISSN: 1432-1440
    Schlagwort(e): Immunohistology ; Skin alterations ; Graft-versus-host disease ; Bone marrow transplantation ; Langerhans cells
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Skin biopsies of 26 patients with leukemia and seven patients with aplastic anemia were investigated before and at different stages after allogeneic bone marrow transplantation (BMT) to establish the immunological criteria which distinguish skin alterations during normal reconstitution from dermal lesions mediated by graft-versushost disease (GvHD). Of the 33 patients studied 27 presented with clinically diagnosed acute and/or chronic GvHD, one patient died of bone marrow rejection. Immunohistological analysis of the respective skin biopsies with selected monoclonal antibodies against human leukocyte antigens (HLA) and differentiation antigens of the lympho-hematopoietic cells revealed low dermal mononuclear cell counts with phenotypically normal constituents in five cases with uncomplicated reconstitution post-grafting. In contrast, increased dermal cellular infiltrates predominantly consisting of Lyt 3+, OKT 8+ T-lymphocytes, as well as of a large number of Ia-like (immune response associated = HLA-D) determinant+ monocytes/macrophages were observed in all patients with active acute/chronic GvH reactivity. As sign of activation simultaneous expression of HLA-D region products was also found on a subset of the invading OKT 8+ T-lymphocytes. Progression of GvHD was associated with additional surface staining of keratinocytes for Ia-like determinants. Loss of Ia-like determinant+, OKT 6+ dentritic epithelial cells in all leukemic patients, as well as in patients with aplastic anemia with or without GvHD suggested damage of Langerhans cells due to the previous radiotherapy and/or specific immunological destruction. In patients with fatal outcome of GvHD prolonged reduction of these dentritic epithelial cells seemed to be indicative of impaired immune reconstitution or bone marrow dysfunction. Thus immunopathological features of skin GvHR may enable early recognition and prognostic evaluation of this disease possibly allowing more effective therapy.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01716464
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  • 4
    Digitale Medien
    Digitale Medien
    Bone marrow transplantation for acute leukemia in second or subsequent remission (1984)
    Springer
    Journal of molecular medicine 62 (1984), S. 1081-1085 
    Details
    ISSN: 1432-1440
    Schlagwort(e): Bone marrow transplantation ; Acute leukemia ; Recurrent leukemia
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary Twenty-one patients with acute leukemia in second to fifth remission were treated with bone marrow transplantation: 19 patients with transplants from HLA-matched siblings and two with transplants from identical twins. Twelve patients survived from 15 to 1,625 days after transplantation: six of 11 in the ALL group and six of 10 in the AML group. Recurrence of leukemia after marrow transplantation occurred in five patients. The cause of death in five patients was infection, in two patients combined with graft-versushost disease. Long-term disease-free survival can probably be achieved in 30%–35% of all patients with acute leukemia who receive a marrow transplant in second or subsequent remission.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01711377
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  • 5
    Digitale Medien
    Digitale Medien
    Restricted infection with canine distemper virus leads to down-regulation of myelin gene transcription in cultured oligodendrocytes (1995)
    Springer
    Acta neuropathologica 90 (1995), S. 312-318 
    Details
    ISSN: 1432-0533
    Schlagwort(e): Canine distemper virus ; Oligodendrocytes ; Myelin gene expression ; Demyelination
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Canine distemper virus (CDV) induces oligodendroglial degeneration and multifocal demyelination in the central nervous system. The mechanism of oligodendrocyte degeneration is not understood but it has been shown that there is a restricted infection of these cells without viral protein production. Using a combination of immunocytochemistry and in situ hybridization we were able to demonstrate the transcription of the entire virus genome throughout the whole observation period (7–35 days after infection) in oligodendrocytes in CDV-infected brain cell cultures. Therefore, the lack of viral protein and particle production can not be explained on the basis of a defective viral transcription. The present study also shows that a restricted infection of oligodendrocytes with CDV down-regulates the transcription of the major myelin genes coding for proteolipid protein, myelin basic protein (MBP) and myelin-associated glycoprotein in a very similar way. Using densitometry for in situ hybridization products of MBP in populations of normal and infected oligodendrocytes, an effect could be observed long before morphological changes were detectable. The present results strongly suggest that demyelination in distemper is induced by a restricted CDV infection of oligodendrocytes which down-regulates the expression of a variety of cellular genes, in particular those coding for myelin proteins. Consequently, the infected cells are no longer able to synthesize all the membrane compounds which are necessary for maintaining their structural integrity.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00296516
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  • 6
    Digitale Medien
    Digitale Medien
    Restricted infection with canine distemper virus leads to down-regulation of myelin gene transcription in cultured oligodendrocytes (1995)
    Springer
    Acta neuropathologica 90 (1995), S. 312-318 
    Details
    ISSN: 1432-0533
    Schlagwort(e): Key words Canine distemper virus ; Oligodendrocytes ; Myelin gene expression ; Demyelination
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Canine distemper virus (CDV) induces oligodendroglial degeneration and multifocal demyelination in the central nervous system. The mechanism of oligodendrocyte degeneration is not understood but it has been shown that there is a restricted infection of these cells without viral protein production. Using a combination of immunocytochemistry and in situ hybridization we were able to demonstrate the transcription of the entire virus genome throughout the whole observation period (7–35 days after infection) in oligodendrocytes in CDV-infected brain cell cultures. Therefore, the lack of viral protein and particle production can not be explained on the basis of a defective viral transcription. The present study also shows that a restricted infection of oligodendrocytes with CDV down-regulates the transcription of the major myelin genes coding for proteolipid protein, myelin basic protein (MBP) and myelin-associated glycoprotein in a very similar way. Using densitometry for in situ hybridization products of MBP in populations of normal and infected oligodendrocytes, an effect could be observed long before morphological changes were detectable. The present results strongly suggest that demyelination in distemper is induced by a restricted CDV infection of oligodendrocytes which down-regulates the expression of a variety of cellular genes, in particular those coding for myelin proteins. Consequently, the infected cells are no longer able to synthesize all the membrane compounds which are necessary for maintaining their structural integrity.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00296516
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  • 7
    Digitale Medien
    Digitale Medien
    Gamma-Hydroxybuttersäure zur Therapie des Alkoholentzugssyndroms bei Intensivpatienten Vergleich zweier symptomorientierter therapeutischer Konzepte (1999)
    Springer
    Der Anaesthesist 48 (1999), S. 89-96 
    Details
    ISSN: 1432-055X
    Schlagwort(e): Schlüsselwörter Gamma-Hydroxybuttersäure ; Alkoholentzugssyndrom ; Intensivstation ; Halluzinationen ; Hypernatriämie ; Metabolische Alkalose ; Key words Gamma-hydroxybutyrate ; Alcohol withdrawal syndrome ; Intensive care unit ; Hallucinations ; Hypernatraemia ; Metabolic alkalosis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Beschreibung / Inhaltsverzeichnis: Abstract Seeing as gamma-hydroxybutyrate (GHB) and benzodiazepines interact with the GABA-transmitter system, we investigated whether GHB can replace the conventional therapy, which uses benzodiazepines in the treatment of alcohol withdrawal syndrome in ICU settings. Methods: 42 chronic alcoholics were included in this prospective and randomized study. Folllowing the development of alcohol withdrawal syndrome, the patients were randomly allocated to the GHB or to the flunitrazepam group. In addition to this, clonidine was administered in order to treat autonomic signs of withdrawal. In cases were hallucinations occurred, haloperidol was administered. Results: There was no significant difference in the efficacy of treatment used in the duration of mechanical ventilation and intensive care unit stay between groups. The patients in the GHB-group required significantly higher dosages of haloperidol and significantly lower dosages of clonidine. 14 out of 21 patients from the GHB-group developed hypernatriaemia and 15 out of 21 developed a metabolic alkalosis. Conclusions: Symptoms of the autonomic nervous system were more effectively prevented by GHB as evident in the lower dosage requirement of clonidine. However, GHB may not sufficiently block the hyperactivity of the dopaminergic system or may have an hallucinogenic effect itself. This may be evident from the higher dosages of haloperidol which were necessary. Due to the latter fact, the administration of GHB cannot be recommended in all patients suffering from AWS in ICU settings.
    Notizen: Zusammenfassung Gamma-Hydroxybuttersäure (GHB) und Benzodiazepine interagieren beide mit dem gabaergen Transmittersystem. Vergleichend wurden sie zur intravenösen Therapie des Alkoholentzugssyndroms bei Patienten einer interdisziplinären operativen Intensivstation eingesetzt. Methodik: 42 alkoholabhängige Patienten, die ein Alkoholentzugssyndrom entwickelten, wurden randomisiert entweder mit GHB oder Flunitrazepam behandelt. Additiv erhielten sie symptomorientiert Clonidin oder Haloperidol. Ergebnis: Zwischen den Gruppen bestanden keine signifikanten Unterschiede in der Effektivität der Therapie und der Dauer der intensivstationären Behandlung. Die Patienten der GHB-Gruppe benötigten jedoch signifikant höhere Dosen von Haloperidol und signifikant niedrigere Dosen von Clonidin. Als Nebenwirkungen traten in der GHB-Gruppe signifikant häufiger eine Hypernatriämie (14 von 21 Patienten) bzw. eine metabolische Alkalose (15 von 21 Patienten) auf. Schlußfolgerungen: Die vegetative Symptomatik war mit GHB besser therapierbar als mit Benzodiazepinen. Als Erklärung für den erhöhten Haloperidolbedarf in der GHB-Gruppe ist eine unzureichende Blockierung des dopaminergen Systems und damit die unzureichende Dämpfung der produktiv-psychotischen Symptomatik sowie ein halluzinogener Effekt der Substanz selbst denkbar. Deshalb kann GHB nur zur Therapie des Alkoholentzugssyndroms mit vegetativer Symptomatik, jedoch nicht bei Halluzinationen empfohlen werden.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001010050672
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  • 8
    Digitale Medien
    Digitale Medien
    Intercurrent complications in chronic alcoholic men admitted to the intensive care unit following trauma (1996)
    Springer
    Intensive care medicine 22 (1996), S. 286-293 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Key words Alcoholism ; Trauma ; Intensive care unit ; Complications ; Infection ; Alcohol withdrawal syndrome
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract   Objective: A chronic alcoholic group following trauma was investigated to determine whether their ICU stay was longer than that of a non-alcoholic group and whether their intercurrent complication rate was increased. Design: Prospective study. Setting: An intensive care unit. Patients: A total of 102 polytraumatized patients were transferred to the ICU after admission to the emergency room and after surgical treatment. Of these patients 69 were chronic alcoholics and 33 were allocated to the non-alcoholic group. The chronic-alcoholic group met the DSM-III-R and ICD-10 criteria for alcohol dependence or chronic alcohol abuse/harmful use. The daily ethanol intake in these patients was ≥60 g. Diagnostic indicators included an alcoholism-related questionnaire (CAGE), conventional laboratory markers and carbohydrate-deficient transferrin. Measurement and results: Major intercurrent complications such as alcohol withdrawal syndrome (AWS), pneumonia, cardiac complications and bleeding disorders were documented and defined according to internationally accepted criteria. Patients did not differ significantly between groups regarding age, TRISS and APACHE score on admission. The rate of major intercurrent complications was 196% in the chronic alcoholic vs 70% in the non-alcoholic group (P=0.0001). Because of the increased intercurrent complication rate, the ICU stay was significantly prolonged in the chronic-alcoholic group by a median period of 9 days. Conclusions: Chronic alcoholics are reported to have an increased risk of morbidity and mortality. However, to our knowledge, nothing is known about the morbidity and mortality of chronic alcoholics in intensive care units following trauma. Since chronic alcoholics in the ICU develop more major complications with a significantly prolonged ICU stay following trauma than non-alcoholics, it seems reasonable to intensify research to identify chronic alcoholics and to prevent alcohol-related complications.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01700448
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  • 9
    Digitale Medien
    Digitale Medien
    Intercurrent complications in chronic alcoholic men admitted to the intensive care unit following trauma (1996)
    Springer
    Intensive care medicine 22 (1996), S. 286-293 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Alcoholism ; Trauma ; Intensive care unit ; Complications ; Infection ; Alcohol withdrawal syndrome
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objective A chronic alcoholic group following trauma was investigated to determine whether their ICU stay was longer than that of a non-alcoholic group and whether their intercurrent complication rate was increased Design Prospective study. Setting An intensive care unit. Patients A total of 102 polytraumatized patients were transferred to the ICU after admission to the emergency room and after surgical treatment. Of these patients 69 were chronic alcoholics and 33 were allocated to the non-alcoholic group. The chronic-alcoholic group met the DSM-III-R and ICD-10 criteria for alcohol dependence or chronic alcohol abuse/harmful use. The daily ethanol intake in these patients was ≥60 g. Diagnostic indicators included an alcoholismrelated questionnaire (CAGE), conventional laboratory markers and carbohydrate-deficient transferrin. Measurement and results Major intercurrent complications such as alcohol withdrawal syndrome (AWS), pneumonia, cardiac complications and bleeding disorders were documented and defined according to internationally accepted criteria. Patients did not differ significantly between groups regarding age, TRISS and APACHE score on admission. The rate of major intercurrent complications was 196% in the chronic alcoholic vs 70% in the non-alcoholic group (P=0.0001). Because of the increased intercurrent complication rate, the ICU stay was significantly prolonged in the chronic-alcoholic group by a median period of 9 days. Conclusions Chronic alcoholics are reported to have an increased risk of morbidity and mortality. However, to our knowledge, nothing is known about the morbidity and mortality of chronic alcoholics in intensive care units following trauma. Since chronic alcoholics in the ICU develop mor major complications with a significantly prolonged ICU stay following trauma than non-alcoholics, it seems reasonable to intensify research to identify chronic alcoholics and to prevent alcohol-related complications.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01700448
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