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Biomedical subjects

A Kramer

Publications and source records attributed to A Kramer.

At least 91 records · Page 5Linked to original sources
PubMed1999

Antimicrobial efficacy of antiseptic mouthrinse solutions.

OBJECTIVE: To assess the activity of different mouthrinse solutions compared to sterile water and sage tea against aerobe bacteria in the oral cavity. METHODS: The extent and the duration of the salivary bacterial count reduction were determined using a uniform model that allows a direct comparison of the different products. In contrast to previous investigations the antimicrobial activity of the tested products was stopped by specific neutralizers immediately after sampling. RESULTS: The obtained results allowed us to classify four categories of mouthrinse solutions according to their antimicrobial properties: Products without any active antimicrobial effect (sterile water, sage tea, Fluomint-Lysoform), products with a weak and temporary effect that does not exceed a salivary bacterial count reduction of 1.5 log of colony forming units (cfu) immediately and 1.0 log cfu 1 h after application (hydrogen peroxide, Meridol, Listerine, Lavasept), products with a strong immediate effect (> or =1.5 log cfu) but no prolonged activity (Betaisodona solution, acriflavine) and finally products that exert a sustained effect of at least 1.0 log cfu 1 h after application (Chloramine T, Gurfix, Skinsept mucosa, Corsodyl, Dobendan, Octenisept). CONCLUSION: The method used in this investigation allows an easy and reproducible evaluation of antimicrobial efficacy and may be part of a future test guideline for efficacy testing of antiseptics.

Adult↗
PubMed1999

Activities of lysozyme and salivary peroxidase in unstimulated whole saliva in relation to plaque and gingivitis scores in healthy young males.

The purpose of the present investigation was to study the suitability of the salivary activity of lysozyme and salivary peroxidase for monitoring the inflammatory state of the gingiva. Salivary peroxidase and lysozyme activities in resting whole saliva were measured in a group of 140 male subjects (aged 18-30 years). A full mouth, clinical assessment of the plaque index (PI) and the sulcus bleeding index (SBI) was made and gingival crevicular fluid (GCF) flow was measured at teeth 16, 12, 24, 36, 32 and 44 with the Periotron 6000. There were no significant differences in the mean values of lysozyme and salivary peroxidase activities between groups with different PI, SBI and GCF flow values. Statistically significant correlations were found among the clinical parameters, with SBI and PI showing the strongest relation (r = 0.47). The correlation between GCF flow and PI was higher (r = 0.43) than the correlation between GCF flow and SBI (r = 0.20). However, there were no statistically significant correlations between the activities of salivary peroxide and lysozyme and the clinical measures of gingival health.

Adolescent↗
PubMed1999

Routine use of bilateral skeletonized internal mammary arteries for myocardial revascularization.

BACKGROUND: Complete arterial myocardial revascularization without the use of saphenous veins grafts was primarily performed on selected patient populations such as the young and nondiabetic. In a recently developed surgical technique, the internal mammary artery is dissected gently as a longer skeletonized artery, providing greater versatility for complete arterial revascularization, without saphenous veins grafts. METHODS: We prospectively evaluated the impact of the routine use of double skeletonized internal mammary artery in 472 patients who underwent coronary artery bypass grafting between April 1996 and June 1997. Their average age was 65 years (30 to 87 years), 383 (83%) were men, and 89 (17%) women. One hundred sixty-nine (36%) of the patients were older than 70 years, and 145 (31%) were diabetic. The average number of grafts was 3.2 per patient (two to six grafts). RESULTS: Operative mortality was 1.7% (n = 8). The mortality of urgent and elective patients was 0.7% (3 of 410 patients), and that of emergency operations was 8.1% (5 of 62 patients; p < 0.01). There were three (0.6%) perioperative infarcts, and 6 patients (1.3%) sustained strokes. Sternal wound infection occurred in 8 patients (1.7%). Postoperative follow-up (1 to 25 months) was available in 462 patients (99%). Two-year actuarial survival was 96.8%, and 92% of the surviving patients are well and free of angina. Neither diabetes mellitus nor old age (>70 years) were significant independent predictors of any early or late untoward events. None of the 70 diabetic patients more than 65 years of age developed sternal wound infection. Chronic lung disease was found to be the only independent predictor for sternal infections. CONCLUSIONS: Routine use of bilateral skeletonized internal mammary artery is a safe replacement for the current myocardial revascularization technique even in the old and diabetic patients.

Adult↗
PubMed1999

Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery.

BACKGROUND: There is controversy about the benefit of surgical repair for atrial septal defect in adults, especially its effect on the incidence of supraventricular dysrhythmias, atrial flutter and fibrillation. We studied their incidence before and after operation. METHODS: We examined surface and 24-hour Holter electrocardiograms before, early (between 3 and 7 days), and late (more than 6 months) after operation, performed at age 42.2 years (range, 18.5 to 74.9 years), in 211 adults with atrial septal defect. Patients were arbitrarily divided into three groups: age 18 to 40 years (n = 101), age 40 to 60 years (n = 83), and age more than 60 years (n = 27). All consecutive patients operated on between January 1988 and December 1996 and having a pulmonary to systemic flow ratio of 1.5:1 or greater were included in this study. RESULTS: The age of patients without arrhythmias before or after atrial septal defect closure (39+/-13 years) was significantly lower than that of patients with flutter (54+/-12 years) or fibrillation (59+/-8 years). The incidence of atrial flutter was influenced by surgical repair as atrial flutter converted to sinus rhythm late after operation in 10 of 18 patients. However, there was no change in the incidence of atrial fibrillation before (n = 28) and after (n = 21) operation. CONCLUSIONS: Our data show that surgical correction of atrial septal defect leads to regression of the incidence of atrial flutter but not fibrillation. Thus, surgical repair of atrial septal defect to abolish supraventricular tachyarrhythmias in adults is warranted, but in patients with fibrillation, it may have to be combined with a Maze operation in the future.

Adolescent↗
PubMed1999

Characterization of neutralizing anti-pre-S1 and anti-pre-S2 (HBV) monoclonal antibodies and their fragments.

Single-chain Fv fragments (scFv) were generated from two murine monoclonal antibodies directed to the neutralizing epitopes of the pre-S1 and pre-S2 region of hepatitis B virus, respectively, using different assembly cloning strategies. The scFv fragments were solubly expressed in E. coli. Dissociation constants were in the nanomolar range for all forms (whole IgG antibodies, Fab fragment and scFv fragments). The epitopes of both antibodies were mapped using solid phase peptide synthesis on continuous cellulose membranes and turned out to be linear determinants. The minimal epitope for the anti-pre-S2 antibody 1F6 was identified to be DPRVRGLYF (amino acid 133-141 of the pre-S region). For the anti-pre-S1 antibody MA 18/7 the minimal epitope proved to be the hexamer LDPAFR (amino acid 30-35 of the pre-S region). Complete substitutional analyses as well as truncation experiments revealed key residues for these antibody-antigen interactions. On the basis of those results we used computer-assisted modeling techniques to suggest models for both antibody-peptide interactions providing insight into the structural basis of these molecular recognitions.

Amino Acid Sequence↗
PubMed1999

Spot synthesis: observations and optimizations.

Positionally addressable syntheses of peptides on continuous cellulose membranes (spot synthesis) have often been reported in detail, but important questions dealing with synthesis quality, reproducibility and subsequent binding assays have largely been under-emphasized. In this report we have investigated some of these problems. The most important results were: (i) the signal intensity of ligate binding to cellulose-bound peptides and the affinity of the corresponding soluble peptides show good correlation, illustrated by three different ligate binding assays; (ii) reducing peptide density on the cellulose avoids the 'ring spot' effect, i.e. where less binding is observed in the spot-center compared to the rim. We recommend a peptide density of 10 nmol/cm2 as a reasonable starting point for further optimization; (iii) statistical analysis of binding assay reproducibility with more than 15000 peptides resulted in a mean standard signal deviation of 0.18; and (iv) optimization of side-chain deprotection revealed that a 30-min pretreatment of the cellulose with 90% trifluoroacetic acid followed by the standard deprotection protocol resulted in higher purity of the synthesized products.

Amino Acid Sequence↗
PubMed1999

[Focal aspects of prevention of infection and hygienic quality management in otorhinolaryngology with special reference to surgical interventions].

The main objective of hygiene in surgery is to avoid, detect, and control hospital infections. This primarily involves protecting the patient from infection, although the protection of health care personnel is also an important consideration. Available means of infection control should be applied in a balanced regime tailored to the specific setting. Every member of the health care team must make it his or her personal responsibility to ensure that infection control measures are intelligently and rigorously applied in every specific antiseptic regime in the vicinity of the patient. Adherence of health care personnel to principles of hygiene is facilitated by appropriate building design, instruments, and procedures codified in the form of hygiene plans. Coordinated working procedures and use of utilities verified at regular intervals reduce the risk of contaminating the patient and the plant and equipment. Aside from the ethical dimension of their origin in the hospital or physician's office, nosocomial infections that prolong the disorder and are accompanied by a reduced long-term survival rate and increased risk of mortality have legal consequences and significantly increase the cost of inpatient and outpatient treatment.

Cross Infection↗
PubMed1999

Sternal wound infections in patients after coronary artery bypass grafting using bilateral skeletonized internal mammary arteries.

OBJECTIVES: This study evaluated the risks of sternal wound infections in patients undergoing myocardial revascularization using bilateral skeletonized internal mammary arteries (IMAs). BACKGROUND: The skeletonized IMA is longer than the pedicled one, thus providing the cardiac surgeon with increased versatility for arterial myocardial revascularization without the use of vein grafts. It is isolated from the chest wall gently with scissors and silver clips, and no cauterization is employed. Preservation of collateral blood supply to the sternum and avoidance of thermal injury enable more rapid healing and decrease the risk of sternal wound infection. METHODS: From April 1996 to August 1997, 545 patients underwent arterial myocardial revascularization using bilateral skeletonized IMAs. The right gastroepiploic artery was used in 100 patients (18%). The average age of the patients was 65 years; 431 (79%) were men and 114 (21%) were women; 179 (33%) were older than 70 years of age; 166 (30%) were diabetics. The average number of grafts was 3.2 per patient. RESULTS: The 30-day operative mortality rate was 2% (n = 11). There were six perioperative infarcts (1.1%) and six strokes (1.1%); 9 patients had sternal infection (1.7%) and 15 (2.8%) had superficial infection. Risk factors for sternal infection were chronic obstructive pulmonary disease and emergency operation. Superficial sternal wound infections were more common in women and in patients with chronic obstructive pulmonary disease, renal failure, or peripheral vascular disease. The 1-year actuarial survival rate was 97%. Two of the six late deaths were not cardiac-related. Late dehiscence occurred in three patients (0.6%). The death rate (early and late) of patients with any sternal complication was higher than that of patients without those complications (33% vs. 2.7%). CONCLUSIONS: Routine arterial myocardial revascularization using bilateral skeletonized IMAs is safe, and postoperative morbidity and mortality rates are low, even in elderly patients and those with diabetes. Chronic obstructive pulmonary disease and emergency operations were found to be associated with an increased risk of sternal infections, and the authors recommend avoiding the use of bilateral skeletonized IMAs in patients with these preoperative risk factors.

Aged↗
PubMed1999

Long-term functional outcome after intensive care.

OBJECTIVE: Although age-related mortality after intensive care unit (ICU) admission has been studied, functional recovery for different age groups following ICU admission is not well characterized. We hypothesized that compared with younger age groups, fewer patients older than age 65 admitted to an ICU would regain their full prehospitalization functional ability and that their recovery would be slower than that of younger patients. DESIGN: A prospective observational cohort study with convenience sampling. SETTING: Intensive care units of an urban university-affiliated Veterans Administration Medical Center. PARTICIPANTS: A total of 222 patients during the first 72 hours after entry to a medical or surgical ICU at the Denver Veteran's Administration Medical Center between September 1991 and July 1992. MEASUREMENTS: We collected baseline data on patient demographics and on the severity of acute illness using the Acute Physiology and Chronic Health Evaluation (APACHE II), Acute Physiology Score (APS), and functional status (highest level of physical activity level 1 month before admission). We recorded survival and patient-perceived global functional status at 6 weeks and 6 months after admission. Post-ICU function was adjusted for baseline function, age, APACHE II, and APS using multiple regression. RESULTS: Average patient age was 62+/-.74 years (mean +/- SEM). Fifty-two percent of the entire cohort returned to baseline function at 6 months. Although baseline function was better for younger people, there was no difference in recovery at 6 weeks in older compared with younger patients. Most functional recovery occurred by 6 weeks, with maintenance of this recovery at 6 months. Baseline function was the major determinant of both 6 week recovery (P < .001) and 6 month recovery (P = .002), whereas APACHE II was not (P = .3). Age predicted recovery significantly (P = .04) at 6 months but not at 6 weeks (P = .26). APACHE II (P < .001) and baseline function (P = .03) predicted mortality. CONCLUSIONS: Older people had worse functional ability at ICU admission, but the proportion of older people who recovered and their rate of recovery was the same as for younger people. Baseline functional status, rather than abnormal physiologic status (as measured by APACHE II) on admission, was the major determinant of recovery, whereas APACHE II was the main correlate of mortality. Together, baseline function and physiologic status provide valuable complementary information for clinically relevant outcomes following an ICU admission.

APACHE↗
PubMed1999

Incidence of secondary pulmonary hypertension in adults with atrial septal or sinus venosus defects.

OBJECTIVE: To examine the incidence of raised pulmonary artery pressure and resistance in adults with isolated atrial septal defect within the oval fossa (so called secundum defect) or sinus venosus defect. DESIGN: A historical, retrospective, unrandomised study. SETTING: A tertiary referral centre. METHODS: Cardiac catheterisation was performed in all patients, with measurement of pulmonary artery pressure and resistance. Pulmonary to systemic flow ratio was calculated using the Fick principle. Pulmonary hypertension was defined as mean pulmonary artery pressure > 30 mm Hg, and increased resistance as an Rp/Rs ratio > 0.3. PATIENTS: All patients with a secundum atrial septal or sinus venosus defect who presented between July 1988 and December 1997 were enrolled in the study. RESULTS: Pulmonary artery pressure and resistance in the patients with sinus venosus defect (n = 31) was higher than in patients with atrial septal defect (n = 138). Pulmonary hypertension was present in 26% of patients with sinus venosus and in 9% of patients with atrial septal defect. The incidence of raised pulmonary vascular resistance was 16% in patients with sinus venosus and 4% in patients with atrial septal defect. The increase in resistance occurred at a younger age in sinus venosus defect than in atrial septal defect. CONCLUSIONS: Patients with sinus venosus defect have higher pulmonary pressures and resistances and develop these complications at younger age than patients with atrial septal defects. Thus they should be managed differently than patients with "simple" atrial septal defects.

Adult↗
PubMed1999

[The efficacy of repeated disinfection of disposable gloves during usage].

The efficacy of disinfecting medical gloves with isopropanol 60% (v/v) while they are worn was assessed for 4 different brands of latex gloves (Biogel Diagnistic (A), Safeskin Satin Plus (B), Safeskin LPE (C) and Baxter Non-Sterile Latex Exam Gloves (D)) and one latex-free nitrile glove (100% Nitrile N-Dex (E)). Even in the presence of coagulated blood disinfection of the gloves was more efficient than disinfection of the bare hand. The efficacy of the disinfection of glove C, D and E decreased if 10 disinfections were carried out successively. An increase of perforations detected with the water inflation test according to EN 455-1 was found for brand E. As gloves of brand C and D became tacky after 10 disinfections, they were inappropriate for manual work. As a result, disinfection with isopropanol 60% (v/v) can be recommended for gloves of brand A and B only. Disinfection of these gloves is admissible e.g. after indirect patient contact, taking blood samples or laboratory work if no visible contamination or perforation has occurred. However, after contact with patients suffering from an infectious disease or carrying multiresistant organisms the gloves have to be changed. The same holds true if the gloves might be contaminated with naked viruses (e.g. Poliomyelitis virus), since virucidal alcoholic hand disinfectants require high concentration thus leading to materials incompatibility.

2-Propanol↗
PubMed1999

[Synthesis, antimicrobial effects and adverse effects of new structures of urea, hydrogen peroxide and tensides].

A substantial extension of the applicability of hydrogen peroxide will be reached by using occlusion compounds of anionic, amphoteric (dipolar ionic), cationic, nonionic, or polyfunctional tensides with hydrogen peroxide in urea. Occlusion compounds with 3 as well as with 4 components containing natural equivalent and antimicrobial effective tensides were synthesized and tested. By synthesis in an anhydrous system the content of active substances as well as the mixture ratio of the components may be adapted to the conditions necessary according to the appropriate purpose. Occlusion compounds are characterized by a broad and well-balanced spectrum of antimicrobial effectivity. Concentrations in the range of 0.1 to 0.4% are practicable to preserve pharmaceutical preparations or technical products, respectively. Several compounds show a sporicidal activity in concentrations between 0.3 and 0.6% and, with an appropriate action time (> 24 h) also a moderate effectivity against polioviruses. In the conventional cell culture, in the perfusion cell culture, and in the phytotoxicity test using cress seed, respectively, low biological activity of the occlusion compounds was found.

Anti-Bacterial Agents↗
PubMed1999

[Handwritten documents of 'Antidotarius magnus'].

The 'Antidotarius magnus'--compiled about 1080 by the archbishop of Salerno, Alphanus--deals with the pharmacological methods of healing and contains nearly 1073 antidots. We have discovered 13 Latin manuscripts of the 'Antidotarius magnus' in the libraries of Basel, Bern, Cambridge, Erfurt, Florence, London, Oxford, Paris and Parma. One should remember that the MS Taurin.I.VI.24 had been totally destroyed in 1904, but this manuscript is still noted in the catalogues of Pasin, Giacosa and Thorndike/Kibre. The most remarkable manuscript--the MS Palat.lat.747--is preserved in the National Library at Florence. The MS Palat.lat.747 is dated to 1153 and seems to be similar to the archetype. We are currently preparing a critical edition based on the oldest manuscripts.

Antidotes↗
PubMed1998

[Routine use of of two internal mammary arteries for coronary bypass grafting--one year experience at the Tel Aviv Medical Center].

The skeletonized internal mammary artery (IMA) is longer, and its immediate spontaneous blood flow is greater than that of the pedicled IMA, thus providing increased versatility for complete, arterial myocardial revascularization without the use of saphenous vein grafts. From April 1996 to May 1997, 583 patients underwent coronary artery bypass grafting here and in 415 (71%) complete arterial revascularization was achieved using bilateral skeletonized IMA. The right gastroepiploic artery was used in 57 (13%); there were 329 males (79%) and 86 women (21%); average age was 64 (30-87) and 175 (36%) were older than 70; 131 (32%) were diabetics. Average number of grafts was 3.2 (range 2-6 grafts). At 30 days, 5 (1.2%) had died and there had been 6 perioperative infarcts (1.4%), 5 CVA's (1.2%), and 6 had sternal wound infections (1.4%). Up to 1-12 months of follow-up was achieved in 409 (99%). Late mortality was 1.4% (of which 3 were noncardiac). 394 (97%) were angina-free at latest follow-up. We conclude that arterial revascularization using bilateral skeletonized IMA is safe, as postoperative morbidity and mortality are low, even in old and diabetic patients.

Adult↗
PubMed1998

[Explant test with skin and peritoneum of the neonatal rat as a predictive test of tolerance of local anti-infective agents in wounds and body cavities].

In vitro culture of peritoneal explants of neonatal rats after previous application of agents simulating wound antisepsis is a sensitive screening method for the determination of the tissue compatibility of local wound antiinfectives. Two test models are differentiated: (1) separated peritoneal explants as a model for chronic or deep wounds and (2) peritoneum in situ in the experimental animal with subsequent extraction and cultivation of the explants. Considering the present state of knowledge the following conclusions can be drawn regarding antisepsis of wounds: Lavasept (0.1%) may be classified as the agent of choice for deep and chronic wounds, for drip-suck irrigation and for antiinfective lavage of body cavities inclusively for peritoneal lavage (0.05%). Taurolidin is antiseptically effective in long term application (> 6 h), and because of its antitoxic effect as well as lack of cytotoxicity it is especially suitable for peritoneal lavage. Betaisodona solution is very well suited for superficial contaminated wounds and can be used in a dilution of 1:10 for short-term rinsing of deep wounds, including body cavities but not for peritoneal lavage. Ethanol causes no inhibition of explant growth and therefore retains its importance in wound antisepsis.

Administration, Topical↗
PubMed1998

Effects of an angiotensin II antagonist on ischemic and nonischemic isolated rat hearts.

BACKGROUND: Increasing evidence suggests that a locally integrated or intramyocardial renin-angiotensin system plays a significant role in ischemia-reperfusion injury. We evaluated the effects of losartan, an angiotensin II type 1 receptor blocking agent, on ischemic and nonischemic isolated rat hearts. METHODS: Using the modified Langendorff model, hearts were perfused with either low or high doses of losartan (18.2 mmol/L or 182.2 mmol/L, respectively) or with saline added to Krebs-Henseleit solution during phase I of the study. During phase II, hearts were exposed to a 60-minute period of global ischemia. Ischemic arrest was induced with warm cardioplegic solution (KCl, 16 mEq/L) containing either high-dose losartan (182.2 mmol/L) or Krebs-Henseleit solution only. RESULTS: During phase I of the study, no statistically significant differences were observed between the low-dose losartan group and the control group. However, hearts treated with high-dose losartan demonstrated an increase in peak systolic pressure, maximum first derivative of pressure, pressure-time integral, coronary flow, and oxygen consumption (p < 0.0001). During phase II, hearts treated with losartan showed a significantly better recovery on reperfusion, as reflected by better contractility (p < 0.001), higher oxygen consumption (p < 0.001), higher coronary flow (p < 0.0001), and lower creatine phosphokinase levels (41.1 +/- 1.7 versus 73.3 +/- 5.6 U/L; p < 0.001). CONCLUSIONS: High doses of losartan have a positive inotropic effect on normally perfused hearts. Given in cardioplegic solution, the drug has a significant protective effect on ischemic isolated rat hearts.

Angiotensin II↗
PubMed1998

Stepwise transformation of a cholera toxin and a p24 (HIV-1) epitope into D-peptide analogs.

We have transformed two peptide epitopes into D-peptide analogs: VPGSQHIDS derived from cholera toxin recognized by the antibody TE33, and GATPQDLNTML from the HIV-1 capsid protein p24 recognized by the antibody CB4-1. The transformation process was performed by stepwise substitution of each single epitope position by all 19 D-amino acids and glycine followed by antibody binding studies and selection of one D-analog for further transformation. Thus, each transformation step introduced one novel D-position into the peptide. For both epitopes complete D-analogs were obtained. The cholera toxin-derived variant dwGsqhydp binds to the antibody TE33 with higher affinity than its original epitope, whereas in the case of the p24-derived analog saGdwwGkssl lower affinity was detected. Both D-peptides are completely stable in serum for several days. Antibody interaction models for both D-molecules were generated by computer-assisted modelling based on the crystal structures of the starting complexes. Compared with the L-peptides, the binding conformation of dwGsqhydp is very similar, whereas saGdwwGkssl displays a completely different interaction mode.

Amino Acid Sequence↗