[Medical-legal aspects of difficult intubations].
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Humans↗
Biomedical subjects
A Weber
Publications and source records attributed to A Weber.
Laparoscopic repair of pleural laceration produced during truncal vagotomy: case report.
A partial pneumothorax developed in a patient undergoing laparoscopic truncal vagotomy when a small pleural laceration was accidentally produced. Changes in oxygen saturation and PETCO2 were immediately detected by the anesthesiologist and measures were taken to maintain the patient's ventilatory stability. The pleural laceration was repaired laparoscopically, and the pneumothorax was corrected by ventilatory manipulation, avoiding the placement of a chest tube. The procedure was completed uneventfully. Literature about the causes of pneumothorax during laparoscopic procedures as well as preventive and therapy viewed.
Aged↗
Stoppa-type laparoscopic repair of complex groin defects.
With the laparoscopic approach, bilateral and complex groin defects can be corrected simultaneously by applying a preperitoneal mesh that covers the entire posterior wall of the groin, using a technique similar to the one described by Stoppa. We present our series of hernias repaired by the transabdominal preperitoneal laparoscopic approach with the Stoppa-type technique. The report consists of 78 cases of bilateral defects, of which 60% were indirect bilateral hernias, 23% direct bilateral, and 17% combined defects; 28.5% were recurrent hernias. Only minor complications were observed (hematomas and urinary retention) in some patients, but all resolved spontaneously. Three recurrences (0.7%) have been seen to this date. This method is recommended as the method of choice for complex groin defects.
Adult↗
[Scopolica carniolica Jacq. tea].
We report a case of plant-poisoning of a young man following the consumption of a self-brewed infusion made of a solanaceous plant, to which he was seduced by his friends. He developed anticholinergic symptoms such as optical hallucinations, confusion, mydriasis and tachycardia. 14 hours after admission the patient was discharged from hospital in good health. With regard to this case we portray the mentioned plant (Scopolica carniolica Jacq.) and discuss the symptoms of belladonna-alkaloid-poisoning and its therapy. Further on, in a short literature survey, we depict the meaning of collective drug experiences with plants containing atropine-like substances in ancient and modern times.
Adolescent↗
Amphotropic retroviral vectors displaying hepatocyte growth factor-envelope fusion proteins improve transduction efficiency of primary hepatocytes.
The development of retroviral vectors with cell-specific targeting capabilities will be an important step toward successful in vitro gene therapy. This article describes the generation of a retroviral vector with enhanced binding abilities for cells bearing the c-Met receptor: the Madin-Darby canine kidney (MDCK) cell line and primary hepatocytes. The human hepatocyte growth factor (HGF) was displayed on murine amphotropic retroviral vectors by fusion to the viral transmembrane envelope glycoprotein (TM). The resulting chimeric envelope HGF-TM was expressed in an amphotropic packaging cell line producing viral particles that display both HGF-TM and the wild-type envelope. These modified viral particles had a titer equivalent to that of unmodified particles. Modified particles infected MDCK cells more efficiently than did unmodified amphotropic retrovirus. Adding anti-HGF antibodies to the viral vector particle supernatant prior to infection confirmed that the increased infection was mediated by the HGF moiety. The chimeric viruses also infected primary mouse and nonhuman primate fetal hepatocytes more effectively. Furthermore, these cells could be induced to proliferate by the modified HGF-TM viruses. Since exogenous HGF is primarily taken up by the liver, these results may have implications for retroviral vector design for liver-directed human gene therapy.
3T3 Cells↗
[The path to "Doctor of Medicine"--how do doctoral candidates evaluate their dissertation?].
BACKGROUND AND OBJECTIVE: The value of medical dissertations has for some time been controversial. Critical opinions have, on the one hand, been directed against the effort required, its duration and the concept behind these dissertations, while asserting, on the other hand, that such dissertations hinder studying and lead to unnecessary lengthening of the medical curriculum. PARTICIPANTS AND METHOD: In collaboration with the Medical School in Hanover a questionnaire was sent to all the 189 dissertationists of one year, to be returned anonymously. It contained 16 questions about the dissertation itself, supervision. time spent on it, total duration of medical course and effect of the dissertation on the individual's medical studies. The answers were evaluated statistically by explorative data analysis. RESULTS: 181 questionnaires could be evaluated (96%). Average age of those questioned was 30.5 years, median duration of medical studies to-data was 13 semesters. For 80% it was the first attempted dissertation. 22% had been working on an entirely experimental topic (laboratory or animal experiments). The median time from starting to submitting the dissertation was 4 years, the median time of the experimental phase one year. Two-thirds of students said that work on the dissertation had not prolonged their studies. Supervision during various phases of the dissertation was overwhelmingly judged to have been "very good" or "good". Altogether 90% of dissertationists thought that it had been personally meaningful, and they would recommend it to younger costudents. CONCLUSIONS: The results of this study show that a universal criticism of medical dissertations does not stand up to detailed enquiry. Successful dissertationists highly rated their value both to themselves and to scientific medicine. The medical dissertation should therefore firmly remain as part of medical studies and of research within them.
Academic Dissertations as Topic↗
Fenofibrate improves microcirculation in patients with hyperlipidemia.
In order to investigate the effect of fenofibrate on microcirculation, 16 patients (5 female, 11 male, age 58 +/- 8 years) were studied with the aid of nailfold capillaroscopy before and after treatment with 200 mg fenofibrate per day over six weeks. Fenofibrate resulted in a significant decrease in triglycerides, total and LDL-cholesterol and apolipoprotein B and an increase in apolipoprotein A. As a parameter of an improved microcirculation the time to peak capillary blood cell velocity during postreactive hyperemia (occlusion of the lower arm for 2 minutes, 200 mmHg) decreased markedly from 45 +/- 5 to 16 +/- 3 s, p < 0.0001). Fibrinogen levels were significantly decreased (p < 0.04) in contrast to other parameters with a possible impact on microvascular perfusion (hemoglobin, hematocrit, mean platelet volume, total protein) and to blood pressure and heart rate. These findings suggest that fenofibrate treatment improves microcirculation in patients with hyperlipidemia. This beneficial effect of fenofibrate may arise from two leading mechanisms. One of these might be the decrease in fibrinogen levels reducing plasma viscosity, the other mechanism might be an indirect effect on functional abnormalities of the vascular endothelium arising from hyperlipdidemia. By lowering plasma lipids fenofibrate is likely to restore the impaired formation or efficacy of the endothelium derived relaxing factor (nitric oxide, NO).
Adult↗
[Is subjective health status a good predictor of work resumption?].
The aim of the study is to investigate how persons with long term work-disability due to low back pain assess their health status and how the subjective health measurement influence work resumption (n = 663). Information on their subjective health status at 42 days after start of work-disability is set in relation to the outcomes "Continued work disability after 84 days" versus "work resumption". Bi- and multivariate analysis show that information on the subjective health status and the subjective work prognosis differs between both groups already after 42 days. The results show that the subjective health status in connection with the subjective work prognosis is a good predictor for "Non-resumption of work", but not a sufficiently good predictor for "Resumption to work".
Adolescent↗
[Objective methods for simulated detection of unilateral deafness with special reference to DPOAE (distortion-product otoacoustic emissions) exemplified by a case report].
The simulation of unilateral deafness is very rare. Objective findings are of special interest if it happens. A patient with alleged deafness on the left-hand side due to commotio cerebri was treated in our hospital. Pure tone audiometry showed deafness on the left-hand side and normal hearing on the right-hand side. However, stapedius reflexes were found ipsilaterally left as well as contralaterally right, at 0.5 to 2 kHz with a stimulation of approximately 90 dB SPL. Transiently evoked otoacoustic emissions (TEOAE) and distortion-product otoacoustic emissions (DPOAE) were measured. The TEOAE had the same reproducibility but a very low response on both sides, such that inner ear function could not be evaluated. In comparison, the DP gram showed clear DP amplitudes over the whole frequency range on both sides. Nonphysiological DPs could be excluded by assessing the DP growth rate at three different frequencies. By means of brainstem electric response audiometry (BERA), with which the IV/V complex was detectable up to stimulation with 20 dB SPL clicks, and the Stenger test, a neural or central hearing loss could be excluded. Normal hearing on the left-hand side was thus confirmed. In cases of simulated deafness it is possible to prove a normal inner ear function by DPOAE. DPOAE therefore complements the list of potential audiological simulation tests.
Adult↗
Mycoplasma nucleases able to induce internucleosomal DNA degradation in cultured cells possess many characteristics of eukaryotic apoptotic nucleases.
It was previously shown (Paddenberg et al (1996) Eur J Cell Biol 69, 105 - 119) that cells of established lines like NIH3T3 fibroblasts and the human pancreatic adenocarcinoma PaTu 8902 line only degrade their chromatin at internucleosomal sites after an apoptotic stimulus when infected with Mycoplasma hyorhinis. In order to distinguish mycoplasma nucleases (Mr 47 - 54 kDa) from already described eukaryotic apoptotic enzymes, the mycoplasma nucleases were partially purified from serum-free culture supernatants and further characterized. Here we demonstrate directly that the enriched mycoplasma nucleases were able to fragment the DNA of nuclease-negative substrate nuclei at internucleosomal sites. The DNA degradation was accompanied by morphological changes typical of apoptosis like chromatin condensation and margination followed by shrinkage of the nuclei. The biochemical characterization revealed that the mycoplasma nucleases had a neutral to weakly basic pH-optimum. They required both calcium and magnesium in the mM range for maximal activation and were inhibited by zinc chloride, EGTA and EDTA. In two dimensional zymograms they migrated as three spots with isoelectic points between 8.1 and 9.5. They were not inhibited by monomeric actin. Our data also demonstrate that nuclear extracts prepared from nuclei isolated from Mycoplasma hyorhinis infected cells contained the mycoplasma nuclease activities leading to their internucleosomal DNA-degradation after incubation in the presence of calcium and magnesium.
Apoptosis↗
Microbial communities of printing paper machines.
The microbial content of printing paper machines, running at a temperature of 45-50 degrees C and at pH 4.5-5, was studied. Bacteria were prevalent colonizers of the machine wet end and the raw materials. A total of 390 strains of aerobic bacteria were isolated and 86% of these were identified to genus and species by biochemical, chemotaxonomic and phylogenetic methods. The most common bacteria found at the machine wet end were Bacillus coagulans and other Bacillus species, Burkholderia cepacia, Ralstonia pickettii, and in pink slimes, accumulating in the wire area and press section, species of Deinococcus, aureobacterium and Brevibacterium. Paper-making chemicals also contained species of Aureobacterium, B. cereus, B. licheniformis, B. sphaericus, Bordetella, Hydrogenophaga, Klebsiella pneumoniae, Pantoea agglomerans, Pseudomonas stutzeri, Staphylococcus and sometimes other enteric bacteria, but these did not colonize the process water. Yeasts and moulds were not present in significant numbers. A total of 131 strains were tested for their potential to degrade paper-making raw materials; 91 strains were found to have degradative activity, mainly species of Burkholderia and Ralstonia, Sphingomonas and Bacillus, and enterobacteria produced enzymes which degraded paper-making chemicals. Stainless steel adhering strains occurred in slimes and wire water and were identified as Burkholderia cepacia, B. coagulans and Deinococcus geothermalis. Coloured slimes were formed on the machine by species of Deinococcus, Acinetobacter and Methylobacterium (pink), Aureobacterium, Pantoea and Ralstonia (yellowish) and Microbulbifer-related strains (brown). The impact of the strains and species found in the printing paper machine community on the technical quality of paper, machine operation, and as a potential biohazard (Hazard Group 2 bacteria), is discussed.
Bacteria↗
LU 302 872 and its racemate (LU 224 332) show balanced endothelin-A/B receptor affinity, high oral activity, and inhibit human prostate tissue contractions.
LU 302 872 (racemate LU 224 332) is a new glycerinic acid derivative related to the selective ETA receptor antagonist LU 135 252. LU 302 872 exhibits high and balanced affinity to ETA and ETB receptors (Ki 2.2 and 5.8 nmol/L), whereas LU 135 252 is ETA-selective (Ki 1.4 and 184 nmol/L). Two hours after oral treatment of rats with 10 mg/kg of LU 302 872 or of LU 135 252, the big ET-1-induced (20 micrograms/kg i.v.) blood pressure increase is inhibited by 59 +/- 8% or 52 +/- 2% (n = 6-8; p < 0.05 vs. control), whereas bosentan is without effect (-6 +/- 7%; n = 6). In guinea pigs, 10 mg/kg p.o. of LU 302 872 inhibited the big ET-1 (20 micrograms/kg i.v.)-induced bronchospasm (reduction in respiratory volume) by 78 +/- 7% (n = 6; p < 0.05), whereas the ETA antagonist LU 135 252 was ineffective (0.2 +/- 37%; n = 6). Hence, a high oral effectiveness of the new ETA/B antagonist could be demonstrated in two species for both an ETA- or an ETB-mediated response. In human prostate tissue (excised during cystectomy in bladder cancer patients), ET-1 and in most cases, the ETB agonist sarafotoxin 6c (S6c) caused contractions of similar magnitude but more sustained than that of norepinephrine (10(-6) mol/L). A high concentration (10(-5) mol/L) of the ETA antagonist LU 135 252 only moderately attenuated ET contractions. The ETA/B antagonist LU 302 872 or its racemate, LU 224 332, dose-dependently inhibited ET-1-induced contractions. S6C dose-response curves, too, were shifted to the right or suppressed by the combined ETA/B antagonist (10(-6) mol/L LU 224 332). LU 302 872 may be a suitable candidate for testing in benign prostate hyperplasia (BPH).
Animals↗
Molecular characterization of a carbon transporter in plastids from heterotrophic tissues: the glucose 6-phosphate/phosphate antiporter.
Plastids of nongreen tissues import carbon as a source of biosynthetic pathways and energy. Within plastids, carbon can be used in the biosynthesis of starch or as a substrate for the oxidative pentose phosphate pathway, for example. We have used maize endosperm to purify a plastidic glucose 6-phosphate/phosphate translocator (GPT). The corresponding cDNA was isolated from maize endosperm as well as from tissues of pea roots and potato tubers. Analysis of the primary sequences of the cDNAs revealed that the GPT proteins have a high degree of identity with each other but share only approximately 38% identical amino acids with members of both the triose phosphate/phosphate translocator (TPT) and the phosphoenolpyruvate/phosphate translocator (PPT) families. Thus, the GPTs represent a third group of plastidic phosphate antiporters. All three classes of phosphate translocator genes show differential patterns of expression. Whereas the TPT gene is predominantly present in tissues that perform photosynthetic carbon metabolism and the PPT gene appears to be ubiquitously expressed, the expression of the GPT gene is mainly restricted to heterotrophic tissues. Expression of the coding region of the GPT in transformed yeast cells and subsequent transport experiments with the purified protein demonstrated that the GPT protein mediates a 1:1 exchange of glucose 6-phosphate mainly with inorganic phosphate and triose phosphates. Glucose 6-phosphate imported via the GPT can thus be used either for starch biosynthesis, during which process inorganic phosphate is released, or as a substrate for the oxidative pentose phosphate pathway, yielding triose phosphates.
Amino Acid Sequence↗
Low dose oral pH modified release budesonide for maintenance of steroid induced remission in Crohn's disease. The Budesonide Study Group.
BACKGROUND: The relapse rate after steroid induced remission in Crohn's disease is high. AIMS: To test whether oral pH modified release budesonide (3 x 1 mg/day) reduces the relapse rate and to identify patient subgroups with an increased risk of relapse. METHODS: In a multicentre, randomised, double blind study, 179 patients with steroid induced remission of Crohn's disease received either 3 x 1 mg budesonide (n = 84) or placebo (n = 95) for one year. The primary study aim was the maintenance of remission of Crohn's disease for one year. RESULTS: Patient characteristics at study entry were similar for both groups. The relapse rate was 67% (56/84) in the budesonide group and 65% (62/95) in the placebo group. The relapse curves in both groups were similar. The mean time to relapse was 93.5 days in the budesonide group and 67.0 days in the placebo group. No prognostic factors allowing prediction of an increased risk for relapse or definition of patient subgroups who derived benefit from low dose budesonide were found. Drug related side effects were mild and no different between the budesonide and the placebo group. CONCLUSION: Oral pH modified release budesonide at a dose of 3 x 1 mg/day is not effective for maintaining steroid induced remission in Crohn's disease.
Administration, Oral↗
What are the parameters for predictive selection of patients requiring anesthesia for extracorporeal shockwave lithotripsy?
OBJECTIVE: Additional anesthesia is required to minimize the tolerable pain level in efficiently performed extracorporeal shockwave lithotripsy (ESWL) with electrohydraulic and electromagnetic sources. In order to assess optimum anesthesia for each patient undergoing a standardized ESWL protocol, pain measurement and scoring were carried out. We attempted to determine the individual type and amount of analgesia prior to treatment. METHODS: Patients (n = 95) with urolithiasis underwent pain measurement and scoring prior to ESWL. 'Threshold of pain' (TP) and 'maximal tolerable pain (MTP) were assessed by inducing ischemia pain with the submaximum effort tourniquet technique. Pain intensity was assessed by a verbal rating scale (VRS). The results of pain measurement and amount of analgosedation were correlated in two phases. Patients were administered an oral premedication of 0.1 mg/kg midazolam. Phase 1: 60 patients were randomized into three groups: (1) piritramide (0.1-0.3 mg/kg) and midazolam (1-3 mg) i.v. (2) Lidocaine/prilocaine cream topically (30 g) to skin and diclofenac supp. 100 mg. (3) No analgesia. Phase 2: Based on the data of phase 1, cut-off points for TP and MTP were set for female and male patients. In accordance with these results, 35 patients comprised group 1 for anesthesia with piritramide/midazolam, group 2 with lidocaine/prilocaine cream and diclofenac supp. and group 3 for no analgesia at all. The electromagnetic shockwave sources Modulith SLX and Lithostar Plus were utilized. RESULTS: Phase 1: All patients randomized for group 1 (intravenous analgosedation) were treated in accordance with the protocol. 65% of group 2 (cream/suppository) tolerated treatment as planned. 35% of patients selected for ESWL without analgesia (group 3) remained within this group. Patients requiring additional analgosedation displayed lower TP and MTP. The cut-off points for females and males were TP >/=25/35 s and MTP >/=45/60 s, respectively. Phase 2: 20/35 patients were preselected for a nonintravenous protocol. Five out of these 20 violated the protocol. The rate of additionally administered analgesia was lower than in phase 1: 35:10% in group 2 (cream/supp.), 65:40% in group 3 (no analgesia). CONCLUSIONS: The TP and MTP levels are lower in patients requiring stronger analgesia. The determined parameters are suitable for patient preselection and individual assessment of anesthesia prior to ESWL. It may be assumed that 50% of patients administered intravenous opioids are overtreated. Routine pain measurement for patient depends on the individual pain tolerance level. A third phase of this study recruiting a large number of patients will contribute to the confirmation of these results.
Adolescent↗
Patient evaluation and comparison of the recovery profile between propofol and thiopentone as induction agents in day surgery.
The patient's subjective perception of the quality of his/her recovery after day case anaesthesia with propofol or thiopentone as induction agents is still controversial. The authors investigated the perception and quality of awakening after anaesthesia during the recovery period and at 24 hours and 72 hours, in outpatients undergoing anaesthesia induced either with propofol or thiopentone and maintained with a volatile anaesthetic. In a double-blind study in adults undergoing knee arthroscopy in a day surgery unit, propofol and thiopentone were compared as induction agents in 60 randomized outpatients. A Critical Flicker Fusion Threshold test (CFFT), verbal test for anxiety, visual analog scale for anxiety and pain, and questionnaires were used to assess objectively and subjectively the quality of anaesthesia and awakening during the postoperative period. Demographic data and mean duration of anaesthesia were similar. In the propofol group, patients awoke more rapidly (9.2 +/- 5.8 vs 12.3 +/- 5.8 min) (P < 0.05); however, the CFFT measurements did not show any significant difference between the groups, except at time = 0 min, when 17 patients in the propofol group were able to perform the test versus only 10 patients in the thiopentone group (P < 0.05). At 4, 24, and 72 hours postoperatively, the authors were unable to detect any difference between the two groups. Except for early recovery, there were no differences between the intermediate and late recovery profiles, when propofol or thiopentone was used as the anaesthetic induction agent in day surgery.
Adolescent↗
Adrenocorticotropin insensitivity syndromes.
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Adrenal Glands↗