[The importance of the living space for the aged. Old trees should not be transplanted].
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Biomedical subjects
A Roth
Publications and source records attributed to A Roth.
Anaphylaxis and coronary disease.
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Acute myocardial infarction associated with pregnancy.
PURPOSE: To review available information on the epidemiology, cause, diagnosis, prognosis, and treatment of acute myocardial infarction during pregnancy or in the early postpartum period and to develop guidelines for the management of this condition. DATA SOURCES: MEDLINE and Index Medicus searches and a manual search of bibliographies from reviewed articles. STUDY SELECTION: Published reports of well-documented acute myocardial infarction during pregnancy or the early postpartum period or potentially relevant information. DATA EXTRACTION: 125 well-documented cases of myocardial infarction were identified. DATA SYNTHESIS: The highest incidence seems to occur in the third trimester and in multigravidas older than 33 years of age. Acute myocardial infarction during pregnancy is most commonly located in the anterior wall. The maternal death rate was 21%; death occurred most often at the time of acute myocardial infarction or within 2 weeks of the infarction and was usually related to labor and delivery. Most fetal deaths were associated with maternal deaths. Coronary artery morphology was studied in 54% of described patients. Coronary atherosclerosis with or without intracoronary thrombus was found in 43% of patients, coronary thrombus without atherosclerotic disease in 21%, coronary dissection in 16%, and normal coronary arteries in 29%. CONCLUSIONS: Acute myocardial infarction during pregnancy or the early postpartum period is rare but may be associated with high risk. Although atherosclerosis can be documented in many cases, coronary dissection and arteries that are normal on angiography are common, especially in acute myocardial infarction occurring in the peripartum or postpartum period. Early diagnosis is often hindered by the normal changes of pregnancy and low level of suspicion. Management should follow the usual principles of care for acute myocardial infarction. However, selection of diagnostic and therapeutic approaches may be greatly influenced by fetal safety.
Adult↗
[Thrombolytic treatment for acute myocardial infarction in menstruating women].
A 44-year-old woman was admitted to the intensive cardiac care unit due to an extensive anterior myocardial infarction of acute onset. Because she was menstruating, thrombolytic treatment was relatively contraindicated. On primary coronary angioplasty, an occluding clot was found in her proximal, left anterior coronary artery. Despite menstrual bleeding, 500,000 IU/10 min of urokinase was infused into the artery. After restoration of blood flow, angioplasty was performed and a 90% residual stenosis was found in the artery. She was then fully heparinized for 5 days and concomitantly given aspirin, 100 mg/day. There were no complications, nor was menstrual bleeding excessive. She was discharged in good clinical and hemodynamic status after 10 days of hospitalization. Based on our experience, and reinforced by an additional 23 cases reported by others, we suggest that thrombolytic treatment should not be withheld even in menstruating women, when access to primary, coronary angioplasty is not available.
Adult↗
Reduction of reinfarction and angina with use of low-molecular-weight heparin therapy after streptokinase (and heparin) in acute myocardial infarction.
This study examined whether extending the anticoagulation effect of heparin by low-molecular-weight heparin (clexane) can prevent recurrent myocardial infarction (AMI) treated by streptokinase. On the fifth day after AMI and after heparin therapy cessation, 103 patients were randomly assigned to either treatment with low-molecular-weight heparin (40 mg subcutaneously per day for 25 days, n=43) or control (no treatment, n=60). All patients were followed carefully for 6 months after the infarction date. A total of 32 patients (31%) sustained a cardiac event during the 6-month observation period. There were 12 patients (20%) with reinfarction in the control group versus 2 patients (4.6%) in the low-molecular-weight heparin group during the first 30 days of the study (p=0.02). One additional patient sustained reinfarction at 3 months of followup in the control group, which yielded a total of 13 patients (21.6%) sustaining reinfarction in the control group versus 2 patients (4.6%) in the low-molecular-weight heparin group during 6 months of followup (p=0.01). Angina pectoris after AMI was diagnosed in 13 control patients (21.6%) versus 4 low-molecular-weight heparin-treated patients (9.3%) (p=0.078) during the study period. No major bleeding events were reported in either low-molecular-weight heparin-treated or control patients. Among patients with recently diagnosed AMI treated by streptokinase, extending the anticoagulant effect of heparin for 25 days may prevent recurrent coronary events for at least one month.
Adult↗
Quantitative analysis of pyridinium crosslinks of collagen in the synovial fluid of patients with rheumatoid arthritis using high-performance liquid chromatography.
The pyridinium crosslinks are important and definite biomarkers of mature hard tissue collagen degradation. A gradient ion-paired reversed-phase high-performance liquid chromatographic method was used for the simultaneous determination of both crosslinks in synovial fluid (SF) samples of 25 patients with rheumatoid arthritis (RA). The mean +/- SD levels of pyridinoline (Pyd) and deoxypyridinoline (Dpyd) in SF were 107.7 +/- 182.3 nmol/l and 4.8 +/- 8.3 nmol/l, respectively. The Pyd/Dpyd ratio, which indicates the amount of Pyd released from cartilage rather than bone, amounted to 30.8 +/- 29.5. This value is significantly higher than in urine or serum of the same patients. These data suggest increased destruction of joint cartilage in patients with RA and the release of collagen II fragments in SF. In addition, the levels of the crosslinks in SF reflect considerable interindividual variation, indicating substantial individual differences in the amount of collagenous material that is degraded.
Adolescent↗
The outcome of patients with acute myocardial infarction ineligible for thrombolytic therapy. Israeli Thrombolytic Survey Group.
PURPOSE: The aim of this study was to determine the proportion of patients with acute myocardial infarction (AMI) excluded from thrombolytic therapy on a national basis and to evaluate the prognosis of these patients by reasons of ineligibility and according to the alternative therapies that they received during hospitalization. PATIENTS AND METHODS: During a national survey, 1,014 consecutive patients with AMI were hospitalized in all the 25 coronary care units operating in Israel. RESULTS: Three hundred and eighty-three patients (38%) were treated with a thrombolytic agent and included in the GUSTO study. Ineligible patients for GUSTO were treated: (1) without any reperfusion therapy (n = 449), (2) by mechanical revascularization (n = 97), or (3) given 1.5 million units of streptokinase (n = 85) outside of the GUSTO protocol. The inhospital and 1-year post-discharge mortality rates were 6% and 2% in patients included in the GUSTO study; 6% and 5% in those mechanically reperfused; 15% and 10% in those treated with thromoblysis despite ineligibility for the GUSTO trial, and 15% and 13% among patients not treated with any reperfusion therapy. CONCLUSIONS: Ineligibility for thrombolysis among patients with AMI remains high. Patients ineligible for thrombolysis according to the GUSTO criteria, but nevertheless treated with a thrombolytic agent were exposed to an increased risk.
Actuarial Analysis↗
Primary cultivation of human synovial cells from nonrheumatic synovial tissue and fluid.
Cultures were established from adherent cells of synovial fluid and from collagenase-dispersed specimens of synovial tissue. In cultures derived from synovial tissue, prolyl hydroxylase-positive cells of fibroblast-like morphology were identified as the predominant cell type. In cultures from synovial fluid the majority of adherent cells was macrophage-like in appearance and strongly positive for CD 68. Cells with a stellate morphology could rarely be observed in cultures from synovial tissue. Their relations to other forms will be discussed. Several simple methods for cultivating adherent synovial cells are presented.
Cell Culture Techniques↗
A comprehensive set of DnaA-box mutations in the replication origin, oriC, of Escherichia coli.
We probed the complex between the replication origin, oriC, and the initiator protein DnaA using different types of mutations in the five binding sites for DnaA, DnaA boxes R1-R4 and M: (i) point mutations in individual DnaA boxes and combinations of them; (ii) replacement of the DnaA boxes by a scrambled 9 bp non-box motif; (iii) positional exchange; and (iv) inversion of the DnaA boxes. For each of the five DnaA boxes we found at least one type of mutation that resulted in a phenotype. This demonstrates that all DnaA boxes in oriC have a function in the initiation process. Most mutants with point mutations retained some origin activity, and the in vitro DnaA-binding capacity of these origins correlated well with their replication proficiency. Inversion or scrambling of DnaA boxes R1 or M inactivated oriC-dependent replication of joint replicons or minichromosomes under all conditions, demonstrating the importance of these sites. In contrast, mutants with inverted or scrambled DnaA boxes R2 or R4 could not replicate in wild-type hosts but gave transformants in host strains with deleted or compromised chromosomal oriC at elevated DnaA concentrations. We conclude that these origins require more DnaA per origin for initiation than does wild-type oriC. Mutants in DnaA box R3 behaved essentially like wild-type oriC, except for those in which the low-affinity box R3 was replaced by the high-affinity box R1. Apparently, initiation is possible without DnaA binding to box R3, but high-affinity DnaA binding to DnaA box R3 upsets the regulation. Taken together, these results demonstrate that there are finely tuned DnaA binding requirements for each of the individual DnaA boxes for optimal build-up of the initiation complex and replication initiation in vivo.
Bacterial Proteins↗
[Disk displacement of the temporomandibular joint: correlation of magnetic resonance tomography and clinical findings].
PURPOSE: To evaluate the value of magnetic resonance imaging (MRI) in symptomatic patients with different degrees of internal derangement. MATERIAL AND METHODS: We prospectively investigated 117 temporomandibular joints (TMJ) of 59 symptomatic patients and 31 asymptomatic volunteers and correlated this with clinical parameters. RESULTS: There was a positive correlation between the degree of internal derangement and deformity of the disc, maximal mouth opening, signal intensity of the posterior band, thickness of the bilaminar zone, proliferative bony changes, size of the condyle and reduced translation movement of the condyle, which in addition moved upward and backward. Patients most often complained of pain which was dependent on the degree of disc displacement and condylar changes. Clinical parameters were found to be inaccurate in predicting disc displacement. CONCLUSION: Patients with internal derangement of the temporomandibular joint may be asymptomatic. Patients history may give the only pointer to the disorder.
Adult↗
[Retinopathy of prematurity and the "immaturity index"].
GOAL: To find an index which enables one to differentiate any high risk premature newborn of developing a retinopathy of prematurity. METHOD: Two groups of newborn are studied: 1) all the children under 2550 g at birth time and born between january 1979 and september 1987 and having had a diagnosis of retinopathy of prematurity, 2) all the children who were examined by the author from october 1987 to july 1990. RESULTS: 33 of the 118 children studied suffered from a retinopathy of prematurity. Small gestational age and weight is considered to be high risk as well as the association with necrotizing colitis, intracranial hemorrhage, hyaline membrane disease and/or bronchopulmonary dysplasia, oxygen therapy and sepsis. For all these factors studied p is less than 0.0001. We utilized the multiple regression coefficients to define the "Immaturity Index". CONCLUSION: The index is very specific in defining any child with no risk of developing the disease. It has a sensitivity of 0.9 in detecting any newborn suffering from a retinopathy over grade 2. It is much more powerful than any biological variable (gestational age or weight, oxygen therapy time) in predicting retinopathies (60%).
Birth Weight↗
Reduction of postoperative adhesion formation after laparoscopic ovarian cystectomy.
The purpose of this randomized, open-label study was to assess the efficacy of the product Interceed absorbable adhesion barrier in the prevention of adhesion formation on the ovary after laparoscopic ovarian cystectomy. A total of 25 patients requiring laparoscopic bilateral ovarian cystectomy were enrolled into this study. After removal of ovarian cysts, peri-adnexal adhesions, and peritoneal irrigants, and the attainment of meticulous haemostasis, the random assignment of one ovary for wrapping with Interceed was revealed to the surgeon. The other ovary served as the untreated control. A follow-up laparoscopy was performed 8-30 weeks after the initial procedure in 17 patients. Significantly fewer adhesions formed at the Interceed treated ovaries compared with the control (untreated) ovaries (P < 0.05). In terms of adhesion-free outcome, 76% (13/17) of Interceed treated ovaries and 35% (6/17) of control ovaries were free of adhesions. A significant reduction was observed in the area of the sutured ovaries involved with adhesions when Interceed (6%) was used, compared with controls (20%). The reduction of adhesion formation was not related to the size of the cysts at the initial procedure. No adverse events were reported by any patient during the study. In conclusion, Interceed was found to be safe and effective in reducing the incidence of postoperative adhesion formation in patients undergoing laparoscopic ovarian cystectomy.
Cellulose, Oxidized↗
High-dose intravenous magnesium attenuates complement consumption after acute myocardial infarction treated by streptokinase.
OBJECTIVE: This study was designed to detect changes in complement levels following acute myocardial infarction and to test whether magnesium sulphate (MgSO4) administration interferes with the complement response that follows acute myocardial infarction. DESIGN: Twenty-nine patients with acute myocardial infarction treated with streptokinase were included and randomly assigned to three treatment groups. In groups A and B, a bolus of 1 g MgSO4 was infused intravenously followed by 4 g (group A) and 14 g (group B) MgSO4 for 24 h while normal saline was administered in group C (control). Blood samples for C3, C4 and CH-100 were obtained at baseline and repeatedly during the 48 h following the initiation of magnesium infusion. RESULTS: In groups A and C, a remarkable decrease in the levels of C3, C4 and CH-100 was observed when measured 1 h after the end of streptokinase infusion and thereafter for the ensuing 48 h compared to baseline values (P < 0.05). In group B, the decrease in these complement elements was attenuated, and a significant (P < 0.05) delayed decrease of C3 and C4 was observed only at 24 h and later up to 48 h. The mean level of CH-100 in group B was significantly depressed compared to baseline from 3 h and thereafter up to 48 h. Mean C3 values plotted against observation time differed between the three groups (P = 0.021). A similar trend was observed for C4 (P = 0.133) but not for CH-100 (P = 0.46). CONCLUSION: (1) Complement elements are being consumed following acute myocardial infarction treated by streptokinase. (2) High-dose intravenous magnesium attenuates the complement process following acute myocardial infarction. (3) These results might signify that magnesium modulates the inflammatory response that follows infarction.
Adult↗
[Lymphocyte subpopulations in spleen and blood after early wound debridement and acute/chronic treatment with hyperbaric oxygen].
Thermal burns as well as hyperbaric oxygen (HBO) may cause immuno-suppression. This is one of the reasons why there is some controversy in the literature regarding adjuvant HBO treatment for thermal burn patient, despite the fact that HBO is known to decrease edema formation and possibly inhibits the progression from second to third degree burns. In this study, lymphocyte subpopulations were labelled with monoclonal antibodies W3/25 for helper cells, and OX-8 for cytotoxic/suppressor cells, to determine changes following early burn wound excision and acute or chronic HBO treatment in a 10% full-thickness burn model in rats. Lymphocyte subpopulations were extracted from blood and spleen on day 1, 8, and 15 following burn and/or treatment. W3/25 cells did not show any significant changes in blood or spleen over time. Significantly lower OX-8 cell counts were found in the group with burn + excision + chronic HBO treatment on day 8 and 15. Acute or chronic HBO treatment alone did not produce evidence of immuno-suppression.
Animals↗
[Transfer of the elderly from the hospital to their home. Time structures in the home are self-determined].
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Caregivers↗
[Late effects of organophosphate poisoning on the heart].
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Animals↗
The DNA binding domain of the initiator protein DnaA.
The 94 C-terminal amino acids of the initiator protein DnaA of Escherichia coli are required and sufficient for specific binding to the cognate DNA binding site. The binding domain contains two potential amphipathic alpha-helices and a third alpha-helix. It represents a new DNA binding motif so far not found in other DNA binding proteins. Temperature-sensitive mutations in the binding motif, dnaA204, dnaA205 and dnaA211, abolish DNA binding. In the solid-phase DNA binding assay, applicable to other DNA binding proteins, fusions of domains of DnaA protein to beta-galactosidase are reacted with biotinylated anti-beta-galactosidase antibody. These are coupled to streptavidin-coated magnetic beads. The DNA binding domain is able to selectively remove the DNA target (oriC) from the liquid phase. Alternatively, the DNA binding domain is fused to a peptide containing a target sequence which is naturally biotinylated in vivo in E.coli. This fusion protein can be coupled directly to streptavidin-coated magnetic beads. Homologies between DnaA protein and transcription factors of the NtrC family are discussed.
Amino Acid Sequence↗
On-site catheterization laboratory and prognosis after acute myocardial infarction. Israeli Thrombolytic Survey Group.
BACKGROUND: Since the introduction of thrombolytic therapy for patients with acute myocardial infarction, the use of coronary angiography has substantially increased. We sought to determine whether the presence of on-site coronary angiographic facilities influenced the utilization of coronary procedures in patients with acute myocardial infarction hospitalized in Israel's coronary care units. METHODS: A prospective survey was conducted in January and February 1992 in the 25 coronary care units operating in Israel, 15 of which had on-site catheterization facilities. Data on demographics, clinical features, thrombolytic therapy, and the type of coronary diagnostic or therapeutic procedures performed during the current in-hospital stay were recorded. Mortality, both in-hospital and 1 year after discharge, was assessed for all patients in the survey. RESULTS: One thousand fourteen consecutive patients with acute myocardial infarction were hospitalized during the survey, 307 (30%) of whom were admitted to 10 coronary care units without and 707 of whom were treated in hospitals with on-site coronary angiography facilities. Demographic and baseline characteristics were similar in both groups. Thrombolytic therapy was provided equally (46%) to patients admitted to hospital with and without catheterization laboratories. Patients admitted to hospitals with these laboratories underwent coronary angiography (26%) and percutaneous transluminal angioplasty and/or coronary artery bypass grafting (12%) in greater numbers than counterparts admitted to hospitals without such laboratories (10% and 5%, respectively). Hospital and cumulative 1-year mortality rates were 11% and 18%, respectively, in patients admitted to hospitals with on-site catheterization facilities vs 10% and 17%, respectively, in the patient group admitted to the other hospitals. Patients receiving thrombolytic therapy had similar hospital mortality rates unrelated to the availability of coronary catheterization laboratories. CONCLUSION: This national survey showed that the availability of invasive coronary facilities led to increased use of diagnostic and therapeutic coronary procedures among patients with acute myocardial infarction. There was no difference in hospital or 1-year mortality rates in patients admitted to hospitals with or without on-site coronary angiographic facilities.
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