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Biomedical subjects

A Berger

Publications and source records attributed to A Berger.

At least 235 records · Page 13Linked to original sources
PubMed1997

Inhibition by pulmonary surfactant Curosurf of secretory phospholipase A2 expression in guinea-pig alveolar macrophages.

Replacement therapy with exogenous surfactant has been proven successful in animal models of acute respiratory distress syndrome (ARDS). Here, we investigated the effect of seminatural surfactant Curosurf on the expression of secretory phospholipase A2 (sPLA2) in guinea-pig alveolar macrophages (AM). The latter produced an sPLA2 activity whose level was markedly reduced when culture medium was supplemented with Curosurf. This effect was concentration-dependent and was accompanied by a decrease in sPLA2 mRNA levels. By contrast, when AM were first cultured for 20 hr and then incubated with Curosurf, no significant change was observed in their sPLA2 activity. Finally, f-Met-Leu-Phe (FMLP)-induced thromboxane B2 release from AM was not altered by Curosurf, indicating that the inhibition of sPLA2 expression cannot be attributed to a nonspecific membraneous effect of Curosurf. These findings show that pulmonary surfactant modulates the expression of sPLA2 in AM and suggest that this effect may account for the clinical efficacy of surfactant replacement therapy in ARDS.

Animals↗
PubMed1997

Does T1, N0-1 vulvar cancer treated by vulvectomy but not lymphadenectomy need inguinofemoral radiation?

PURPOSE: The objective of our study was to demonstrate differences in relapse rates, total survival times, and complication rates between inguinofemoral radiation and its absence in cases of invasive vulvar carcinoma without lymph node involvement (FIGO Stages T1, N0-1). METHODS AND MATERIALS: From 1974 to 1990, 135 patients with invasive vulvar carcinoma in Stage T1 without clinical evidence of inguinal lymph node involvement underwent simple vulvectomy performed by hot-knife resection without lymphadenectomy. Although 65 patients (Group 1) received postoperative inguinofemoral radiation therapy, 70 patients (Group 2) did not, and none received local vulva irradiation. RESULTS: The 5-year survival rates were 93.7% in Group 1 and 91.4% in Group 2 (p = NS). Although clitoris involvement was significantly more prevalent in the irradiation group (p = 0.04), inguinal relapse was found less frequently in Group 1 (4.6% or 3 out of 65 patients) than in group 2 (10% or 7 out of 70 patients) (p = 0.32). The complication rates were, 7.7% in Group 1 and 2.9% in Group 2, 2.7% for vaginal stenosis (two patients in each group), 1.5% for inguinal pain (one patient in Group 1), 1.5% for rectovaginal fistula (one patient in Group 1), 1.5% for vulvar infection (one patient in Group 1). CONCLUSION: No statistically significant differences in the relapse rates and survival times were found. Risk factors were equally distributed in both study groups except for clitoris involvement. The 5-year survival rates in both groups were similar to those reported in the literature for radical vulvectomy and inguinal lymph-node dissection (83-96%). Morbidity in our study was low. Although our data showed similar results in both groups, we are not recommending at this time to omit groin radiation in general, but it may be justified in low-risk cases.

Adenocarcinoma↗
PubMed1997

Divergence in signal transduction pathways of platelet-derived growth factor (PDGF) and epidermal growth factor (EGF) receptors. Involvement of sphingosine 1-phosphate in PDGF but not EGF signaling.

Platelet-derived growth factor (PDGF) and serum, but not epidermal growth factor (EGF), stimulated sphingosine kinase activity in Swiss 3T3 fibroblasts and increased intracellular concentrations of sphingosine 1-phosphate (SPP), a sphingolipid second messenger (Olivera, A., and Spiegel, S. (1993) Nature 365, 557-560). We report herein that DL-threo-dihydrosphingosine (DHS), a competitive inhibitor of sphingosine kinase that prevents PDGF-induced SPP formation, specifically inhibited the activation of two cyclin-dependent kinases (p34(cdc2) kinase and Cdk2 kinase) induced by PDGF, but not by EGF. SPP reversed the inhibitory effects of DHS on PDGF-stimulated cyclin-dependent kinases and DNA synthesis, demonstrating that the DHS effects were mediated via inhibition of sphingosine kinase. DHS also markedly reduced PDGF-stimulated but not EGF-stimulated mitogen-activated protein kinase activity and DNA binding activity of activator protein-1. Examination of the early signaling events of PDGF action revealed that DHS did not affect PDGF-induced autophosphorylation of the growth factor receptor or phosphorylation of the SH2/SH3 adaptor protein Shc and its association with Grb2. This sphingosine kinase inhibitor did not abrogate activation of phosphatidylinositol 3-kinase by PDGF. In agreement, treatment with SPP had no effect on these responses but did, however, potently stimulate phosphorylation of Crk, another SH2/SH3 adaptor protein. Moreover, DHS inhibited PDGF-stimulated, but not EGF-stimulated, Crk phosphorylation. Thus, regulation of sphingosine kinase activity defines divergence in signal transduction pathways of PDGF and EGF receptors leading to mitogen-activated protein kinase activation.

3T3 Cells↗
PubMed1997

[The differential indication for "open" or "endoscopic" carpal tunnel release].

Carpal tunnel syndrome is one of the most common nerve compression syndromes. Nocturnal paresthesia and pain are early symptoms, and hypesthesia and thenar atrophy are late symptoms. These days endoscopic and open operation techniques are available. Minimal trauma after endoscopic release allows early return to work. The endoscopic technique should be performed by experienced surgeons to avoid severe complications.

Adult↗
PubMed1997

[Tendovaginitis stenosans of the thumb in small children (pollex flexus congenitus). The authors' results and review of the literature].

Our personal treatment concept for trigger thumb in children is presented. The guiding symptoms are fixed flexion deformity, (painful) restriction of motion (with a click phenomenon) or persistent extension deformity. Although it is a simple pathology, careful diagnosis is mandatory to rule out other reasons with the same symptoms as trigger thumb, as some of these will lead to severe aesthetic and functional impairment. In 26 patients with persistent symptoms, the A1 ring ligament of the thumb was cut. Free active and passive joint motion was comparable to the opposite side in 92.7% of patients. In 2 cases a secondary operation was necessary because of incomplete A1 ring ligament release. If it is diagnosed and operated on early with a careful operative technique, nowadays no aesthetic or functional impairment should occur in children because of trigger thumb.

Child↗
PubMed1997

[Intrabronchial surfactant administration in inhalation trauma of severely burned patients with ARDS. Initial case reports].

Damage to the respiratory system caused by inhalation of toxic products of combustion and the subsequent development of adult respiratory distress syndrome (ARDS) are the main lethal factors in burns patients. Treatment with exogenous surfactant is one of the therapeutic options. However, no clinical reports have yet been published about this therapy. We report on two patients with burn injuries of second to third degree affecting 42% and 48% respectively of the total body surface plus inhalation injury complicated by ARDS. Both patients were treated with bovine surfactant (Alveofact). The therapeutic effects on oxygenation and pulmonary function were monitored. Intrabronchial application of surfactant by bronchoscopy during exhaustive conventional mechanical ventilation resulted in improved gas exchange with an increase in arterial O2 pressure (paO2); inspired O2 concentration (FiO2) was lowered and there was an improvement in lung compliance. Both patients survived this critical situation. We conclude that treatment with exogenous surfactant in postburn victims with ARDS is a promising therapeutic approach to improve the survival rate of these high-risk patients.

Adult↗
PubMed1997

[Surgical replantation].

In the early days of replantation surgery, if viability was restored the operation was judged a success. Nowadays restoration of viability alone is not sufficient to fulfill the criteria of successful replantation, which are as follows: Lack of severe systemic disturbances due to the replantation, a "functional extremity" according to the definition of Chen et al. (1978), no or little pain at the site of the replantation, good aesthetic results, and an acceptable length of time for rehabilitation and return to normal life. Successful replantation needs a therapy concept that is based on an exact definition of the amputation injury from the viewpoint of the amount of severance, the level of the amputation, and the type of amputation mechanism, complete knowledge of current replantation indications, and exact selection of patients amenable for replantation.

Amputation, Traumatic↗
PubMed1997

[Enchondroma of the hand. Clinical evaluation study of diagnosis, surgery and functional outcome].

Enchondroma are benign cartilaginous tumors and are localized most often at the site of the phalanges. Between 1982 and 1993 73 patients with monostotic enchondroma and 5 patients with polyostotic enchondroma were operated at our clinic. Clinical signs of monostotic tumors were pathological fracture (38.4%), pain or swelling. Eleven percent of cases were accidental findings. Surgical treatment was performed by complete removal of the tumors and filling the bone cavity with autologous spongiosa taken from the pelvic bones, the elbow, or the radius. Three patients (4.1%) had to be operated a second time due to wound infections and hematoma. In one case Sudeck's dystrophy was diagnosed. One patient (1.4%) developed a recurrent tumor. Our follow-up examination of 65 patients showed that 77% of the patients with monostotic enchondroma achieve very good or good functional long-term results after this operation, but only 40% of the patients with polyostotic enchondroma.

Bone Neoplasms↗
PubMed1997

[New developments in covering post-traumatic soft tissue defects].

Posttraumatic soft tissue defects, alone or combined with fractures, still present challenging problems of diagnosis and choice of treatment, unless they are suitable for primary closure. The reasons are to be found in their varied ethiology and degree of severity. In order to apply the optimal therapy to the patient, a complete understanding of the defect present, an optimal timing of surgery and a full knowledge of all treatment options are mandatory. The treatment concept presented is based on our personal experience between 1981 and 1995 after more than 5000 skin transplantations, some 3000 local tissue transfer, over 200 distant flap transfers and more than 1200 free microvascular tissue transfer to all regions of the body. New therapy concepts do not entirely replace the elder ones, but are integrated into the treatment schedule.

Combined Modality Therapy↗
PubMed1997

[Secondary replacement operations for reconstruction of elbow joint function after lesion of the brachial plexus].

Elbow flexion plays a key role in the overall function of the upper extremity. In the case of unilateral complete brachial plexus lesion, restoration of elbow flexion will dramatically increase the patient's chances of regaining bimanual prehension. Furthermore, depending on the type of reconstruction, stability of the glenohumeral joint as well as some supination function of the forearm can be restored to a varying degree at the same time. Depending on the level of brachial plexus lesion and/or reinnervation, different reconstructive procedures are available. In order to select the best treatment option for the patient it is necessary to known the extent of the lesion of the brachial plexus and/or ventral upper arm muscles, to time the operation appropriately, to be aware of all treatment possibilities and to recall the special problems of tendon transfer for brachial plexus patients. Our concept is based on our experience with more than 1100 patients presenting a brachial plexus lesion between 1981 and 1996 and treated in our institution. There were 528 operative revisions of the brachial plexus. Some 225 patients underwent secondary muscle/tendon transfers. In 35 patients elbow flexion was reconstructed by bipolar latissimus dorsi transfer (n = 10), triceps-to-biceps transfer (n = 15), modified flexor/pronator muscle mass proximalization (n = 6) and the multiple-stage free functional muscle transfer after intercostal nerve transfer (n = 4).

Arm↗
PubMed1997

Systemic liberation of interleukin-8 in the perioperative phase of liver transplantation.

Serum levels of interleukin-8 (IL-8) were investigated in the perioperative phase of liver transplantation (LTx) in order to help determine whether this cytokine might serve as a parameter for preservation injury. In a study of 45 patients undergoing LTx, systemic IL-8 was estimated at the end of the anhepatic phase, at 30, 60, and 120 min after reperfusion of the graft, and 24 h and 7 days after LTx. A maximum mean concentration of 665 +/- 135 pg/ml was seen 60 min after LTx. The minimum was found on the 1st postoperative day (POD 1): 328 +/- 33 pg/ml. Significant changes were found between 60 min and PODs 1 and 7, as well as between 120 min and POD 1. Differences in cold ischemia time were not found to be significant. We conclude that monitoring of systemic IL-8 levels is not useful in the development of new liver preservation concepts.

Adult↗
PubMed1997

Percutaneous endoscopic gastrostomy (PEG). 8 years of clinical experience in 232 patients.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is now a standard method for providing long-term enteral nutrition in patients who are unable to swallow. The aim of our study was to document clinical data that would allow prediction of a possible complicated clinical course. METHODS: The study was carried out retrospectively. Clinical data of patients having received a PEG tube by a single endoscopic technique were analyzed. RESULTS: Some 5. 17% of 232 patients showed complications requiring surgery including a mortality rate of 0.43%. Patients with complications had a significantly lower body mass index and there was a significantly higher complication rate in patients having obstructive malignancies compared with benign diseases. CONCLUSIONS: Low body mass index and advanced malignancies are predictors for complications after PEG application. Early installation should help prevent further nutritional deterioration and the related risk of complications.

Adolescent↗
PubMed1997

Gene therapy for tissue repair: approaches and prospects.

Recent advances in molecular biology have resulted in the development of new technologies for the introduction and expression of genes in human somatic cells. This emerging field, known as gene therapy, is broadly defined as the transfer of genetic material to cells/tissues in order to achieve a therapeutic effect for inherited as well as acquired diseases. We and others are exploring the potential application of this technology to tissue repair. One primary focus has been to transfer genes encoding wound healing growth factors, a broad class of proteins which control local events in tissues such as cell proliferation, cell migration and the formation of extracellular matrix. Using several different strategies for gene transfer, wound healing growth factor genes have been introduced and expressed in cells and tissues in vitro as well as in vivo. Various experimental models of wound healing and tissue repair have been used to evaluate the efficacy of this new and exciting approach to tissue repair.

Blood Vessel Prosthesis↗
PubMed1997

Recombinant Bet v 1, the major birch pollen allergen, induces hypersensitivity reactions equal to those induced by natural Bet v 1 in the airways of patients allergic to tree pollen.

BACKGROUND: Atopic allergens produced by recombinant DNA methods are promising tools for diagnosis and therapy of Type I allergy. To evaluate the immunologic properties of these molecules, it is necessary to compare them with natural allergens in vitro and in vivo. OBJECTIVE: The study was carried out to determine whether the potency of recombinant Bet v 1 (rBet v 1) is comparable to that of natural Bet v 1 (nBet v 1) in inducing allergic reactions in the nose and bronchi. METHODS: Thirteen patients allergic to birch pollen with bronchial asthma and/or rhinitis were investigated. Skin prick tests and nasal and bronchial challenges were performed with rBet v 1 and nBet v 1. RESULTS: In patients allergic to birch pollen, both allergens induced comparable skin reactions. In subjects with rhinitis rBet v 1 was equally potent in inducing nasal reactions (mean PD(+60)NR +/- SD, 10.48 +/- 17.42 microg vs 7.98 +/- 8.9 microg, p > 0.05). In patients with asthma, rBet v 1 was equally potent in inducing bronchial reactions (PD20 FEV1, 0.81 +/- 1.74 microg vs 0.62 +/- 1.44 microg, p > 0.05) as nBet v 1. CONCLUSION: No significant differences were observed between natural and recombinant allergen. We conclude that allergens produced by recombinant techniques can induce typical allergic reactions in important target organs of Type I allergy: the nose and bronchi.

Adult↗