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A Herold

Publications and source records attributed to A Herold.

At least 19 recordsLinked to original sources

Definition of a consensus transportin-specific nucleocytoplasmic transport signal.

The low cytoplasmic and high nuclear concentration of the GTP-bound form of Ran provides directionality for both nuclear protein import and export. Both import and export factors bind RanGTP directly, yet this interaction produces opposite effects; in the former case, RanGTP binding induces nuclear cargo release, whereas in the latter, RanGTP binding induces nuclear cargo assembly. Therefore, nuclear import and export receptors and their protein recognition sites are predicted to be distinct. Nevertheless, the approximately 38-amino acid M9 sequence present in heterogeneous nuclear ribonucleoprotein A1 has been reported to serve as both a nuclear localization signal and a nuclear export signal, even though only one protein, the nuclear import factor transportin, has been shown to bind M9 directly. We have used a combination of mutational randomization followed by selection for transportin binding to exhaustively define amino acids in M9 that are critical for transportin binding in vivo. As expected, the resultant approximately 12-amino acid transportin-binding consensus sequence is also predictive of nuclear localization signal activity. Surprisingly, however, this extensive mutational analysis failed to dissect M9 nuclear localization signal and nuclear export signal function. Nevertheless, transportin appears unlikely to be the M9 export receptor, as RanGTP can be shown to block M9 binding by transportin not only in vitro, but also in the nucleus in vivo. This analysis therefore predicts the existence of a nuclear export receptor distinct from transportin that nevertheless shares a common protein-binding site on heterogeneous nuclear ribonucleoprotein A1.

Amino Acid Sequence

Laparoscopic surgery for rectal prolapse and outlet obstruction.

PURPOSE: The aim of this study was to assess the outcome of both laparoscopic suture rectopexy and resection-rectopexy in the treatment of complete and incomplete rectal prolapse, outlet obstruction, or both. METHODS: Data from surgery were collected prospectively. Semiannual follow-up was performed by assessment of recurrence, continence, and constipation using patients' history, physical examination, continence score, and anorectal manometry. Statistical analysis was performed by chi-squared test and Student's t-test (P < 0.05 was accepted as statistically significant). RESULTS: Between September 1992 and February 1997, 72 patients (68 females) with a mean age of 62 (range, 23-88) years were treated laparoscopically. Indications for surgery were rectal prolapse in 21 patients, rectal prolapse combined with outlet obstruction in 36 patients, and outlet obstruction alone in 15 patients. Standard procedure was a laparoscopic suture rectopexy. A sigmoid resection was added in 40 patients. Mean duration of surgery was 227 (range, 125-360) minutes for rectopexy and 258 (range, 150-380) minutes for resection-rectopexy. Conversion was necessary in 1.4 percent (n = 1). Overall complication rate was 9.7 percent (n = 7) and mortality rate was 0 percent. Mean postoperative hospitalization was 15 (range, 6-47) days. All patients with a minimal follow-up of two years (n = 53) could be enrolled in a prospective follow-up study (mean follow-up, 30 months). No recurrence of rectal prolapse had to be recognized. Sixty-four percent of patients with incontinence before surgery were continent or had improved continence. In patients experiencing constipation preoperatively, constipation was improved or completely removed in 76 percent. No additional symptoms of constipation occurred after surgery. CONCLUSION: Laparoscopic procedures in the treatment of pelvic floor disorders, e.g., rectal prolapse or outlet obstruction, lead to acceptable functional results. However, follow-up has to be extended and long-term results of recurrence, continence, and constipation have to be evaluated.

Adult

[Diagnostic evaluation of the rectum and pelvic floor in chronic constipation].

In outlet constipation an exact diagnostic evaluation is always necessary because of the different etiologies, multiple combinations in primary and secondary lesions and the number of therapeutic alternatives. Basic diagnostics start with the very important, structured evaluation of the patient's history, colorectal examination including inspection, palpation, procto-, recto-, sigmoidoscopy and anorectal manometry. Depending on the results of this primary evaluation the following methods are indicated: neurophysiologic evaluation (basic neurological examination, EMG, PNTML), defecography ev. including colon contrast enema and gastrointestinal transit time studies. If the complete problem could not be ruled out till that point, the following examinations might be helpful: dynamic pelvic floor MRI, anorectal endosonography, rectal motility studies, fecoflowmetry, colonoscopy, urological und gynecological examinations.

Adult

Determination of the functional domain organization of the importin alpha nuclear import factor.

Although importin alpha (Imp alpha) has been shown to act as the receptor for basic nuclear localization signals (NLSs) and to mediate their recruitment to the importin beta nuclear import factor, little is known about the functional domains present in Imp alpha, with the exception that importin beta binding is known to map close to the Imp alpha NH2 terminus. Here, we demonstrate that sequences essential for binding to the CAS nuclear export factor are located near the Imp alpha COOH terminus and include a critical acidic motif. Although point mutations introduced into this acidic motif inactivated both CAS binding and Imp alpha nuclear export, a putative leucine-rich nuclear export signal proved to be neither necessary nor sufficient for Imp alpha nuclear export. Analysis of sequences within Imp alpha that bind to the SV-40 T antigen NLS or to the similar LEF-1 NLS revealed that both NLSs interact with a subset of the eight degenerate armadillo (Arm) repeats that form the central part of Imp alpha. However, these two NLS-binding sites showed only minimal overlap, thus suggesting that the degeneracy of the Arm repeat region of Imp alpha may serve to facilitate binding to similar but nonidentical basic NLSs. Importantly, the SV-40 T NLS proved able to specifically inhibit the interaction of Imp alpha with CAS in vitro, thus explaining why the SV-40 T NLS is unable to also function as a nuclear export signal.

Amino Acid Sequence

Nucleocytoplasmic shuttling by protein nuclear import factors.

Protein nuclear import factors are not, in general, believed to function in the nuclear export of macromolecules and their reutilization therefore requires their recycling from the nucleus to the cytoplasm. Two possible mechanisms for recycling have been proposed. On the one hand, protein import factors such as importin beta and transportin (Trn) could continuously shuttle between cytoplasm and nucleoplasm. On the other hand, these proteins could penetrate into the nucleus only as far as the inner surface of the nuclear pore complex and then directly return to the cytoplasm. In this manuscript, we have used microinjection analysis in human cells, and in vitro nuclear assays, to demonstrate that importin beta, transportin and importin alpha are all nucleocytoplasmic shuttle proteins that efficiently enter and exit the cell nucleoplasm. In the case of transportin, we have mapped sequences required for nucleocytoplasmic shuttling to the carboxy-terminal 270 amino acids of this 890 amino acid import factor, thus demonstrating that nuclear export is independent of the amino-terminal Ran-binding domain of Trn. We further show that Trn shuttling is independent of nuclear RNA transcription. Overall, these data suggest that nucleocytoplasmic shuttling is likely to be a general attribute of protein nuclear import factors.

Binding Sites

[Megacolon in adults--the spectrum of underlying intestinal innervation disorders].

The association of megacolon in adults and Hirschsprung's disease was reevaluated by the morphological assessment of the enteric nervous system. Whole-mount preparations of the resected colonic segments and an immunohistochemical treatment with the pan-neuronal marker protein gene product 9.5 allowed an optimal visualization of the entire intramural nervous plexus layers. The findings included different forms of intestinal neuronal malformations (hypoganglionosis, neuronal intestinal dysplasia, and heterotopic ganglia) apart from classic aganglionosis, thus indicating their etiologic relevance to the development of megacolon in adults.

Adult

Laparoscopic implantation of Oreopoulos-Zellermann catheters for peritoneal dialysis.

For the implantation of continuous ambulatory peritoneal dialysis (CAPD) catheters, both the laparoscopic technique and the use of an Oreopoulos-Zellermann catheter have been suggested to be preferable to the open technique using Tenckhoff catheters. Building on advantages of known techniques, we here describe a procedure for the laparoscopic implantation of the Oreopoulos-Zellermann catheter. The procedure is quick, efficient and unstressful to the patient. After nearly 10,000 patient-days of catheter use, we find positive results with regard to permanently good inlet and outlet flows, low incidence of exit site infections and leaks from the catheter tunnel.

Adult

[Laparoscopic rectopexy].

Within 4 years 66 laparoscopic rectopexies were performed. The indications were: rectal prolapse, morphologic outlet-constipation and a combination of both. Using a modified suture rectopexy (according to Sudeck), we did not take any foreign material and resected the sigmoid in 35 patients. Conversion rate was 2%, complications that needed reoperation occurred in 9%. In the follow up period of 24.1 months in the mean (max. 50) no recurrent prolapse occurred. Incontinence was abolished or improved in 64%, outlet-constipation was improved in 85%. Especially in rectopexy the laparoscopic technique seems to be of benefit for the patient: quicker convalescence, less pain, small scars, a.o. But all these potential advantages have to be proven in prospective-if possible randomised-studies.

Adult

[Laparoscopic surgery of rectal carcinoma].

Laparoscopic colorectal procedures for treatment of benign disorders are increasingly appreciated. However, laparoscopic resections for rectal cancer are controversial. In the Department of Surgery at the Medical University of Lübeck 25 patients with rectal cancer were treated by laparoscopic procedures within four years. Using four trocars the intraabdominal dissection of the sigmoid colon and rectum including mobilisation of the left flexure were performed. A complete lymphadenectomy with high ligation of the inferior mesenteric artery and dissection of the mesocolon and colon were accomplished by laparoscopic techniques. There was no case requiring conversion to open surgery attributable to intraoperative complications. Apart from stoma complications one venous bleeding occurred postoperatively requiring laparotomy. The median lymph node harvest were 12 nodes. Laparoscopic colorectal surgery for rectal cancer is oncologically feasible. Concerning long-term outcome and due to the problem of port site recurrences laparoscopy for rectal cancer should be offered only to patients enrolled in a prospective randomized trial.

Aged

[Laparoscopic therapy of functional disorders of the rectum and pelvic floor].

Within 4.5 years, 72 laparoscopic rectopexies were performed. The indications included rectal prolapse, morphologic outlet-constipation and a combination of both. Using a modified suture rectopexy (according to Sudeck), without taking any foreign material we resected the sigmoid in 39 patients. In four cases, a resection of the sigmoid colon was carried out. Conversion rate was 2% and complications that needed reoperation occurred in 9%. No patient died; laparotomy rate was only 4%. In the mean follow up period of 24.1 months (max. 50 months), no recurrent prolapse occurred. Incontinence was abolished or improved in 64% and outlet-constipation was improved in 85%. Laparoscopic rectopexy with or without sigmoid resection seems to be of benefit for the patient: quicker convalescence; less pain; small scars; no recurrence; and improvement of constipation and incontinence.

Adult

[Laparoscopic abdomino-perineal rectum excision].

In the department of surgery at the Medical University of Luebeck 10 laparoscopic abdomino-perineal rectum resections were performed within 2 years. Using 3-4 working trocars the intraabdominal dissection of the rectum and sigmoid colon, complete lymphadenectomy with radicular dissection of the inferior mesenteric artery and vein, and dissection of the mesocolon and colon were accomplished. Following a conventional perineal excision the specimen was delivered through the perineal wound. The procedure is finished by establishing a conventional colostomy using the upper left trocar incision. The operation times ranged from 4 to 7.5 hours. The patients--51 to 82 years old--left hospital within 2 weeks after operation. 18 months after operation all patients operated with curative intention were still alive and tumor free except one patient, who died after a heart attack without any recurrent tumor. Two smaller, local stoma complications and one venous bleeding occurred postoperatively. There was no conversion to open surgery caused by intraoperative complications. The abdomino-perineal resection seems to be an ideal indication for laparoscopic surgery, because of its completely intraabdominal preparation, the excellent laparoscopic view into the small pelvis, the oncologic lymphadenectomy and the unproblematic delivery of the specimen.

Aged

[Intraluminal expansion of a small intestine segment--animal experiment principles and possible clinical application].

In this study we expanded ileal segments of 8 pigs with an intraluminal expander over a period of 6 to 8 weeks till the volume had reached approximately sixfold of the starting volume. The morphological and morphometrical examinations showed flattened villi with elongated crypts and especially an increase in the thickness of the muscularis. The villi appeared flattened through scanning microscopy as well, but the structure of the microvilli was nearly normal. The proliferative activity in the muscularis, estimated immunohistochemically by a monoclonal antibody against PCNA, showed a threefold increase. So it can be assumed, that the increased thickness of the muscle layer was caused not only by muscle cell hypertrophy but also by hyperplasia. The activity of the alpha-glucosidase, a brush border enzyme, was clearly reduced. The minor cause of this effect was the direct damage of the microvilli from the expander, but the major cause was the exclusion of the ileal segment from the small bowel passage and the resulting lack of nutrients. With our technique it seems possible to create an ileum pouch, a stomach substitute or a urinary bladder substitute.

Animals

[Laparoscopic implantation of Oreopoulos-Zellermann catheters for peritoneal dialysis].

For the insertion of CAPD-catheters the laparoscopic implantation technique and the use of Oreopoulos-Zellermann catheters have been shown to be advantageous if compared with the open technique using Tenckhoff catheters. The implantation procedure shown here makes it possible to place the Oreopoulos-Zellermann catheter laparoscopically, combining different advantages. The procedure is quick, efficient and not stressful for the patients. After 4700 days of catheter-use in the patients positive results are seen with regard to permanently good inlet and outlet flows, low incidences of catheter exit site infections and leakages of the catheter tunnel.

Adult

[Staged diagnosis of anorectal incontinence].

The complex function of the anal sphincter is established by different functional compartments. Additionally a wide range of incontinence therapies-surgical and conservative-are possible. Therefore a differentiated diagnostic procedure is necessary to indicate the optimal, individual therapy: symptom-orientated step-by-step incontinence diagnostic program. This starts with a basic coloproctological evaluation using patient's history, continence scores, inspection, palpation, proctoscopy and rectoscopy. Functional and morphological evaluation is done by anorectal manometry, endosonography and neurologic procedures. Only in special cases the following procedures are necessary in addition: defecography, transit-time studies, magnetic resonance imaging, colonoscopy, gynecological and urological diagnostics.

Diagnosis, Differential

[Incisional hernias after laparoscopic interventions].

The importance of the complication incisional hernia after laparoscopic surgery was determined by analyzing our own cases and extensive review of the literature. The data recorded give its incidence as 1 in 550 cases. The most frequent event was intestinal incarceration with a high portion of Richter's hernias. To avoid postlaparoscopic hernias the important step is suturing the fascia when the trocar diameter exceeds 5 mm. When external suturing of the fascia is impossible, the laparoscopic technique using the Reverdin needle is a sufficient procedure for fascial closure after minimally invasive surgery.

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