A rare cause of gastrointestinal bleeding in a patient with hyper-IgE syndrome.
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Adult↗
Biomedical subjects
A Schlesinger
Publications and source records attributed to A Schlesinger.
[Multiple paradoxical emboli in patent foramen ovale].
HISTORY AND CLINICAL FINDINGS: A 38-year-old man was admitted because of angina pectoris with concomitant dyspnoea. Three months previously he had suffered an ischaemic stroke of the right middle cerebral artery and was treated in a neurological department. At that time, no aetiologic diagnosis was possible. There was no history of other diseases. Pulse rate was 100 beats per minute with a blood pressure of 140/60 mm Hg. The left calf had a 4 cm greater circumference without any symptoms. The rest of the physical examination in the markedly overweight patient was normal. INVESTIGATIONS: The ECG showed sinus rhythm and negative T-waves in leads V1-V4 and a slightly elevated ST-segments in II, III and aVF. An acute coronary thrombosis was ruled out by left heart catheter-angio. DIAGNOSIS, TREATMENT AND COURSE: Within the following hours, embolic occlusion of the left popliteal artery developed and was treated with a Fogarty catheter. On the first postoperative day, the patient complained about mild dysaesthesia of his right arm. Duplex sonography showed a floating thrombus in the left carotid bifurcation. The thrombus was removed surgically. Later a pulmonary embolism due to deep vein thrombosis in the left thigh and calf was found. Transoesophageal echocardiography performed in another hospital previously was repeated and a patent foramen ovale (PFO) with a middle-sized shunt was found. The patent foramen ovale was closed percutaneously by implanting a Cardioseal-Starflex occluder. There was neither a complication nor a residual shunt. Neurological symptoms disappeared completely within the next few months. The patient has now been free from new neurological events for 11 months. CONCLUSION: In patients with PFO, paradoxical embolism remains a challenging diagnosis that can be made highly probable by documentation of venous thromboses, pulmonary embolism, missing evidence of atherosclerosis in the vessels of the embolized organ and exclusion of other cardiovascular sources of emboli and prothrombotic coagulation disorders. Interventional closure of a patent foramen ovale appears to be the treatment of choice in proven paradoxical embolism.
Adult↗
Wnt signalling in Caenorhabditis elegans: regulating repressors and polarizing the cytoskeleton.
Wnt proteins are secreted, cysteine-rich glycoprotein ligands with numerous roles during animal development. Recent studies of endoderm induction during embryogenesis in the nematode Caenorhabditis elegans challenge the prevailing view that Wnt signalling specifies cell fate by converting transcriptional repressors into activators. Instead, a mitogen-activated protein kinase (MAPK)-related pathway converges with Wnt signalling in C. elegans to relieve transcriptional repression. Furthermore, Wnt signalling induces endoderm in part by aligning the mitotic spindle in a responding cell along the anterior-posterior body axis. To orient mitotic spindles, Wnt signalling might directly target the cytoskeleton, prior to any regulation of gene transcription in responding cells.
Animals↗
Wnt pathway components orient a mitotic spindle in the early Caenorhabditis elegans embryo without requiring gene transcription in the responding cell.
In a four-cell-stage Caenorhabditis elegans embryo, Wnt signaling polarizes an endoderm precursor called EMS. The polarization of this cell orients its mitotic spindle in addition to inducing endodermal fate in one daughter cell. Reducing the function of Wnt pathway genes, including a newly identified GSK-3beta homolog called gsk-3, disrupts endoderm induction, whereas only a subset of these genes is required for proper EMS mitotic spindle orientation. Wnt pathway genes thought to act downstream of gsk-3 appear not to be required for spindle orientation, suggesting that gsk-3 represents a branch point in the control of endoderm induction and spindle orientation. Orientation of the mitotic spindle does not require gene transcription in EMS, suggesting that Wnt signaling may directly target the cytoskeleton in a responding cell.
Amino Acid Sequence↗
Postural control, attention and sleep deprivation.
We investigated the effect of sleep deprivation on postural control during a simple reaction time task (SRT), during a task requiring the intermittent inhibition of a reaction (IRT), and in the absence of a concurrent information processing task. Postural sway, i.e. changes in center of pressure on a force platform, was recorded in three increasingly difficult standing conditions (fixed platform, sway-referenced platform and sway-referenced platform with sway-referenced visual scene) during the three information-processing task conditions. Five healthy subjects performed the tasks either after normal sleep or following 24 h of sustained wakefulness. As hypothesized, sleep deprivation significantly increased postural sway only in the IRT condition. Within the IRT condition, sleep deprivation significantly increased sway across all postural conditions.
Adult↗
Wnt signaling polarizes an early C. elegans blastomere to distinguish endoderm from mesoderm.
A polarizing signal induces endoderm production by a 4-cell stage blastomere in C. elegans called EMS. We identified 16 mutations in five genes, mom-1 through mom-5, required for EMS to produce endoderm. mom-1, mom-2, and mom-3 are required in the signaling cell, P2, while mom-4 is required in EMS. P2 signaling downregulates an HMG domain protein, POP-1, in one EMS daughter. The sequence of mom-2 predicts that it encodes a member of the Wnt family of secreted glycoproteins, which in other systems activate HMG domain proteins. Defective mitotic spindle orientations in mom mutant embryos indicate that Wnt signaling influences cytoskeletal polarity in blastomeres throughout the early embryo.
Alleles↗
Weight gain and increased concentrations of receptor proteins for tumor necrosis factor after patients with symptomatic HIV infection received fortified nutrition support.
OBJECTIVE: To determine whether certain nutrients and dietary factors act as modulators of the immune system and improve the nutritional status of immunocompromised patients. DESIGN: Controlled, double-blind, crossover phase trials of the effects of a fortified formula in patients infected with the human immunodeficiency virus (HIV). Patients consumed a control formula for 4 months and a study formula for 4 months. SUBJECTS: Ten men with symptomatic HIV infection who were following stable medication regimens and had no malignancies, mycobacteriosis, or additional virus infection requiring systemic treatment. INTERVENTION: Formula fortified with alpha-linolenic acid (1.8 g/day), arginine (7.8 g/day), and RNA (0.75 g/day) and a standard formula. MAIN OUTCOME MEASURES: Nutritional status determined by anthropometric, bioelectrical, biochemical, and dietary assessment; energy expenditure determined by indirect calorimetry; disease progression; CD4 lymphocyte counts; HIV p24 antigen plasma concentrations; tumor necrosis factor (TNF) receptor proteins; and compliance control parameters. STATISTICAL ANALYSES PERFORMED: Student's t tests for paired and unpaired data. RESULTS: Fortified nutrition resulted in a weight gain (+ 2.9 kg/4 months vs -0.5 kg/4 months with the control formula, P < .05), an incorporation of eicosaenoic acid into erythrocyte cell membranes (+ 47% of baseline values, P < .05), and increased plasma arginine concentrations (96.8 +/- 45.1 vs 51.8 +/- 20.9 mumol/L, P < .01). The serum concentrations of the soluble tumor necrosis factor receptor (sTNFR) proteins increased during the study period (sTNFR 55 = + 0.23 vs -0.40 ng/mL, P < .001; sTNFR 75 = + 0.90 vs -0.36 ng/mL, P < .01), whereas no changes in CD4+ lymphocyte counts were observed. CONCLUSION: Increasing dietary intakes of n-3 polyunsaturated fatty acids, L-arginine, and RNA increased body weight, possibly by modulating the negative effects of TNF.
Adolescent↗
Percutaneous endoscopic gastrostomy in AIDS and control patients: risks and outcome.
OBJECTIVES: Wasting is a major feature of advanced HIV infection. Enteral nutrition via percutaneous endoscopic gastrostomy (PEG) is a safe and efficient therapy in malnutrition, but limited experience exists in wasted HIV patients. Here we report on outcome and risk of PEG-feeding in HIV patients compared with HIV-seronegative patients and with HIV patients without PEG. METHODS: In 47 HIV-infected patients, PEG was placed because of wasting (n = 33), neurologic deficits (n = 11), or dysphagia (n = 3). Clinical, immunological, and nutritional data were compared with those of i) 15 HIV patients who refused PEG placement despite an appropriate indication, ii) 76 HIV patients without signs of malnutrition, and iii) 43 miscellaneous PEG patients. RESULTS: PEG was as safe in HIV-infected as in HIV-seronegative patients. PEG feeding resulted in significant increases of body weight (+3.3 +/- 3.6 kg, p < 0.001), serum albumin concentration (+4.5 +/- 7.2 g/L, p < 0.005), and total iron-binding capacity (+9.5 +/- 11.5 mumol/L, p < 0.001). Moreover, our data indicate that PEG feeding may improve survival in wasted AIDS patients. CONCLUSIONS: PEG feeding is safe and effective in the treatment of the AIDS wasting syndrome. Further prospective investigations are necessary to answer the question of whether treatment of wasting improves patient survival.
Acquired Immunodeficiency Syndrome↗
Variability in Cobb angle measurements in children with congenital scoliosis.
The variability in measurement of angles in congenital scoliosis is not known, but it is postulated that it is larger than that in adolescent idiopathic scoliosis due to skeletal immaturity, incomplete ossification, and anomalous development of the end-vertebrae. To determine this variability, we selected 54 radiographs of adequate quality showing 67 scoliotic curves from children with congenital scoliosis. The end-vertebrae were preselected. Each curve was measured by the Cobb method on two separate occasions by six different observers, using the same goniometer and marker. The intraobserver variability was +/- 9.6 degrees and the interobserver variability +/- 11.8 degrees. If 'significant progression' is to be used as a criterion for surgical fusion in congenital scoliosis, there should be at least a 23 degrees increase, the entire range of the interobserver variability, in the curvature to ensure that the perceived increase is not due to variability in measurement.
Analysis of Variance↗
Effects of experience and case difficulty on the interpretation of pediatric radiographs.
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Bias↗
Home enteral nutrition in patients with Acquired Immunodeficiency Syndrome.
UNLABELLED: 14 patients in advanced stages of HIV infection (1 ARC, 13 AIDS; sex: 1 female, 13 male; age 37.8 +/- 6.3 years; body mass index (BMI): 17.4 +/- 2.4 kg/m(2)) were followed prospectively while receiving home enteral nutrition (observation period: 62 +/- 75 days). Artificial nutrition was indicated because of severe weight loss (9-38 kg within 6-48 months, n = 7) or cerebral toxoplasmosis with eating and swallowing disorders (n = 7). In all patients a defined formula diet (175 +/- 17.7 kJ/kg body weight) was administered through an endoscopically placed gastrostomy tube (PEG). Home enteral nutrition was well tolerated by all patients and no significant PEG-related complications occurred. Enteral nutrition resulted in significant increases in body weight (p < 0.005), body cell mass (BCM, p < 0.05), total body fat (TBF, p < 0.005), serum albumin concentration (p < 0.05), and serum total iron-binding capacity (transferrin, p < 0.01). CONCLUSION: Home enteral nutrition via PEG is safe and well tolerated in patients with advanced HIV-related immunodeficiency and is capable of improving nutritional state including BCM.
Journal Article↗
[Preoperative intestinal lavage with a polyethyleneglycol-containing solution. A prospective randomized study in comparison with Ringer's lactate solution].
UNLABELLED: Aim of that study was to prove, whether a solution containing polyethyleneglycol (PEG) is more useful in comparison to the normal method using Ringer's-lactate solution for preoperative bowel preparation. METHODS: From January 1990 up to February 1991 we compared in a prospective randomized simple blind study on 110 patients the whole gut solution (Hewitt) to a bowel preparation with PEG (Oralav). RESULTS: The patients, that were prepared in the common way (Ringer's-lactate, control group; n = 54) were approximately given the double amount of liquid (9663 ml) as those in the other group (target group; n = 54: 4777 ml). We found no significant differences concerning the electrolytes. Hemoglobin (-1.1 g/dl) and hematocrit (-3.5%) were significantly lower in the control group. Both groups showed a similar frequency of nausea (control group 25% vs target group 34%). Vomiting was mainly found in the control group (20.8% vs 1.9%). Both groups showed comparably good results in bowel cleansing. Between the two groups we found no differences in specific bowel bacterial flora. Characteristic and number of postoperative complications were similar low (5.7 vs 3.8%). CONCLUSIONS: Due to a better compliance by oral application, the lower given amounts of liquid and the equal cleansing effect we prefer the use of the PEG containing solution (Oralav).
Adult↗
Asymmetrical ventricular enlargement secondary to recent cerebrovascular accident as demonstrated by cisternography.
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Aged↗
Bilomas: a new approach to the diagnosis and treatment.
Biloma, a newly described entity, appears to have gained a heightened clinical interest recently. During the past 18 months we have diagnosed 9 abnormal biliary collections. We discuss here the role of sonography and radionuclide cholescintigraphy in the evaluation of bilomas. The diagnosis of all cases was confirmed by ultrasound-guided percutaneous needle aspiration. Subsequently 7 patients were treated with catheter drainage, obviating the need for any surgery.
Adult↗
Diaphyseal presentation of Paget disease in long bones.
The authors report a case of polyostotic Paget disease including bilateral tibial involvement with sparing of the ends of each bone. Bone scans with technetium-99m-methylene diphosphonate demonstrated increased activity at the ends of the tibiae, suggesting atypical progression from the shaft toward the joint. This appears to be the first such report to include scintigraphic correlation.
Aged↗
The attenuation of exercise-induced bronchospasm by ascorbic acid.
In order to study the potential benefit of ascorbic acid in asthma we investigated its role in exercise-induced bronchospasm (EIB). Twelve asthmatic subjects were recruited on the basis of findings compatible with EIB. On two subsequent days the subjects ingested 500 mg. of ascorbic acid or a placebo. The study was performed in a double-blind randomized fashion. Partial and maximal expiratory flow volume (PEFV and MEFV) curves were used to determine pulmonary function changes. Pretreatment with ascorbic acid led to a significant attenuation of the bronchospasm seen five minutes after exercise compared to placebo, as measured by FVC (0.23 +/- 0.08 L decrease after ascorbic acid, 0.48 +/- 0.14 L decrease after placebo) and by FEV1 (0.24 +/- 0.06 decrease after ascorbic acid, 0.44 +/- 0.14 decrease after placebo) Mean +/- SE). These results suggest a mild antibronchospastic action of ascorbic acid in subjects with EIB.
Adult↗
Maintaining the quality of American life.
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Economics↗