[Comments on the article by B. Maier et al. Iotrolan versus Iopamidol. A controlled double-blind study in lumbar myelography].
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Contrast Media↗
Biomedical subjects
B Maier
Publications and source records attributed to B Maier.
[A comparison of different endotracheal tubes. Tracheal cuff seal, peak centering and the incidence of postoperative sore throat].
UNLABELLED: The study objective was to evaluate cuff seal, tube tip position and incidence of postoperative sore throat in three different endotracheal tubes: the reusable Rüsch "red rubber" tube (low-volume, high-pressure cuff) and the disposable Rüsch "Super Safety Clear" and Mallinckrodt "lo-pro" tubes (both high-volume, low-pressure cuffs). METHODS: In a prospective randomized trial, 150 consecutive patients scheduled for minor orthopaedic surgery under standardized general anaesthesia, including standardized cuff pressure control, were allocated to one of the three types of endotracheal tube. Leakage and intratracheal tube tip position were investigated by means of fiberoptic tracheoscopy via the endotracheal tube, preceded by pharyngeal instillation of indigocarmine. The semi-standardized interviews for the recording of postoperative sore throat were performed once a day under double-blind conditions from the day of operation to postoperative day 3. Statistical independence testing was based on the chi 2-test, significance was assumed at P < 0.05. MAIN RESULTS: A past-cuff leakage of the pharyngeally instilled dye was found in three patients with "red rubber" tubes. In all of these cases the tracheal cross section deviated markedly from circular. The tips of the "Super Safety Clear" tubes tended to be better centred (P = 0.099). Bad tip position, however, had little influence on postoperative throat complaints (P = 0.394). The differences in incidence of postoperative throat complaints between the "red rubber" (48.9%), "Super Safety Clear" (35.6%) and "lo-pro" tubes (34.1%) did not reach the 5% level (P = 0.288). Such complaints, however, were significantly more frequent in females and in obese patients who exceeded their Broca weights by more than 25%. By contrast, postoperative throat complaints did not vary statistically significantly by age group, tracheal cross-sectional shape, use of atropine or duration of intubation. CONCLUSION: Despite the economic (usable up to 100 times) and ecological (less PVC waste) advantages of the rubber tube, the disposable tubes with high-volume, low-pressure cuffs tended to be superior regarding cuff seal, tube tip position and incidence of postoperative throat complaints. Nevertheless, the continued use of "red rubber" type reusable tubes may be justified in cases where the tube has to stay in place for only a short time.
Adult↗
Dup 3(q) syndrome and neuroblastoma.
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Abdominal Neoplasms↗
Colour Doppler imaging of intracranial vasculopathy in severe infantile sialidosis.
Neonatal ascites is usually attributed to prenatal infections, lysosomal storage disease and anomalies of the genitourinary tract, gastrointestinal tract or cardiovascular system. We report one case of neonatal ascites associated with infantile sialidosis. Cerebral sonography showed stripe-like intracerebral echogenicities in the region of the basal ganglia. Colour Doppler imaging demonstrated blood flow within the echogenicities confirming the suspected diagnosis of intracranial vasculopathy.
Adult↗
[Hemostatic disorders following polytrauma--the role of physiologic coagulation inhibitors during the preclinical phase].
Coagulation changes due to polytrauma are considered to be an important determinant for the outcome. In this context, physiological inhibitors of activated coagulation are highlighted with special reference to antithrombin-III (AT-III). Blood samples of 20 randomly selected adults with polytrauma (Injury Severity Score mean = 36.7 +/- 8.6) were investigated. To investigate the very early onset of coagulation changes, samples were taken as early as possible at the site of emergency (mean = 18.3 +/- 5.5 min. after trauma) as well as at hospital admission (mean = 78.0 +/- 10.4 min.). By means of a specially designed "mini-lab", basic processing of the samples harvested (centrifugation, pipetting, freezing) was done on the spot to obtain haemostaseological results that agree as closely as possible with the subsequent analyses. Due to the activation of intravascular coagulation as well as the consumption of physiological inhibitors, comprehensive coagulation disturbances become obvious at the time of hospital admission. These are intensified by haemodilution as a consequence of high-dose fluid replacement. However, significantly elevated levels of specific coagulation reaction products (thrombin-antithrombin-III-complex) give evidence of the consumption of inhibitory potential exceeding haemodilution.
Adult↗
[Iotrolan versus iopamidol. A controlled double-blind study with lumbar myelography].
Within the frame work of lumbar myelography, 158 patients were entered in a double-blind study in order to test a dimeric contrast medium (iotrolan) against a monomeric one (iopamidol), both of them non-ionic. A three-step scheme was applied to evaluate the X-ray pictures with respect to contrast quality. Particular attention was paid to the visibility of details, i.e. the nerve root and its course, as well as to how well it could be distinguished in the nerve root sheath. On the basis of a high level of significance (P less than 0.05), comparison of the two contrast media showed no difference in contrast quality. Sixty-nine percent of the examinations using iotrolan resulted in excellent contrast quality, whereas the corresponding very good results using iopamidol lay at 76%. Twenty-nine percent of the patients examined with iotrolan and 27% of those examined with iopamidol showed side effects. Headache occurred most frequently, followed by nausea, dizziness and neck pain. Sixty percent of the patients suffering from postmyelographic reactions reported delayed headache, which occurred most often with iotrolan rather than iopamidol. As for manifestation of other postmyelographic side effects, there were no significant differences (P less than 0.05, Fischer's test) between the two groups of contrast media.
Adult↗
[Results of treatment of early functional therapy following incomplete fibular ligament rupture].
Up to now, the inversion trauma of the ankle joint is one of the most important and frequent injuries. The functional treatment has come to a point of advantages in the therapeutic regime. Nevertheless a follow-up is necessary. In a follow-up examination, in the average of 27 months after trauma, 90.3% of the patients have satisfactory or better results. In all patients a stress tenography is carried out. Between radiologic finding and clinical situation is no direct correlation. In the treatment of fibular ligament rupture it is necessary to find out the patients with chronic instability. They have a benefit in an early reconstructive operation of the fibular ligaments.
Adolescent↗
A comparative assessment of the roles of CD8 and CD2 in the functions of activated murine CD8+ T lymphocytes.
Both CD8 and CD2 are T cell surface receptors involved in physical cell interaction and in transmembrane signalling. The present paper addresses their role in the induction of two different functions of the cloned murine cytotoxic T cell C196: target cell lysis and IFN-gamma production. These functions were induced in C196 either by stimulation with the specific stimulator/target cell P815 or, bypassing specific recognition, by the aCD3 hybridoma 145-2C11 or by solid phase aTCR antibodies. These responses were tested for their susceptibility to inhibition/enhancement by a panel of aCD8 and aCD2 mAb. In addition, CD8 deficient and CD8/CD2 double-deficient variants of C196 were transfected with the CD8 and CD2 genes and the resulting cell lines were analysed for their functional capacities. The following results were obtained: (i) CD8 is primarily important in the specific recognition process of activated CTL; (ii) transmembrane signalling of activated CTL through the TCR does not require CD8, nor is it sensitive to modification through CD8; (iii) CTL can nevertheless be directly activated through CD8; however, this is restricted to induction of cytotoxicity but does not result in IFN-gamma production; (iv) CD2 does not seem to be important in any of these responses.
Animals↗
Interstitial deletion of 16(q13q22) in a newborn resulting from a paternal insertional translocation.
A dysmorphic newborn showed an interstitial deletion of the long arm of a chromosome 16 due to a balanced paternal insertional translocation 46,XY,ins(14;16)(q23;q13q22). The insertion was confirmed by chromosomal in situ suppression (CISS-) hybridization. Clinical features considered to be typical for a 16q- phenotype are demonstrated in this patient. Similar observations described in the literature are compared and discussed with reference to the phenocritical region.
Chromosome Deletion↗
[Respiratory disorders in trauma patients. Pulse oximetry as an extension of prehospital diagnostic and therapeutic possibilities].
The early diagnosis and adequate treatment of respiratory complications in trauma cases has a decisive influence upon the patients' posttraumatic development. Pulse oximetry enables us to evaluate and monitor the prehospital respiratory situation objectively for the first time. Within a prospective study conducted from October 1988 to October 1989 in 336 unselected, primarily traumatized, emergency patients rescued by our "SAR Ulm 75" helicopter team, to determine the possibilities and limitations of this method, we maintained continuous pulse oximetric monitoring in all cases. The practical applicability and functional stability of the pulse oximeters used were adequate. On-the-spot intubation was necessary in 45% of the patients (or they were intubated prior to our taking over). Oxygen inhalation by nasal cannula was needed in 55%. While not being decisive for immediate intubation, monitoring with a pulse oximeter does play an essential role in controlling respiratory therapy. In 32% of our cases, pulse oximetric monitoring permitted early adjustment of the respiratory therapy to meet the patients requirements. This method is of special value in disclosing life-threatening respiratory complications (9.3%) i.e., valve pneumothorax. Within a group with a high percentage of multiple traumas (27%) and thorax traumas (39%), this was of enormous assistance in the differential diagnosis. Level and rate of increase of oxygen saturation can be an indication of the severity of a thorax trauma. The limitations of pulse oximetric monitoring, especially those resulting from low peripheral perfusion in trauma cases (7 patients), are fairly rare.
Adult↗
Frequencies and interactions of regulatory T cells. I. The balance between help and suppression regulates the primary immune response to keyhole limpet hemocyanin in vitro.
Frequencies and efficiencies of regulatory T cells from non-immunized mice were estimated in several assay systems differing from each other in cellular composition and antigen dose (NIP-KLH). The NIP-specific and total IgM responses were quantified. Using 10(4) syngeneic B cells and 50 micrograms/ml NIP-KLH, helper (Th) cells from 5 day immune donors were detected in frequencies of 1:3000-1:4000 in lymphnode and spleen T cells, with an efficiency of 70-90 ng IgM/Th cell in C57B1/6 mice. In non-immune spleen T cells, Th cells were observed in frequencies of 1:16,000-1:38,000, with comparable efficiency, but these Th cells appeared suppressed at increased T cell doses. Polyclonal activation led to the appearance of multiple independently regulated populations of Th cells with similar efficiencies. In the presence of 10(5) syngeneic spleen cells, treated once with anti-Thy-1 antibody and complement and 50 micrograms/ml NIP-KLH, suppressor activity was observed in the same T cell population. Similar to help, suppression fluctuated with increasing T cell numbers. Using 1 x 10(6) spleen cells and 50 micrograms/ml NIP-KLH as assay system, T cells enhanced the responses. Again, several independently regulated populations were observed, with efficiencies slightly higher than those of the above-described Th cells. By maintaining the cellular components of the assay system constant (10(4) B cells) and titrating the antigen, Th cell frequencies showed little variation up to 100 micrograms/ml NIP-KLH and were always suppressed at higher T cell numbers. At 200 micrograms/ml NIP-KLH, the frequency was increased to approximately 1:2000, and not suppressed, i.e., was identical to the frequency observed in mice immunized 5 days previously. Efficiencies increased with increasing doses of antigen. The results strongly indicate that regulatory T cell function shows "plasticity", in the sense that the appearance and the frequencies of helping and suppressing T cell populations highly depend on the micro-environment present in culture.
Animals↗
Autoreactive T cell clones from mice infected with Mycobacterium bovis, strain Bacillus Calmette-Guérin (BCG). I. Phenotype, specificity and in vitro function.
Mice were infected with the intracellular microorganism, Mycobacterium bovis BCG, and draining lymph node cells were collected. A T cell line was established which was cultured in the presence of syngeneic accessory cells (AC) and killed BCG. Stimulation of this line depended on syngeneic accessory cells and did not require BCG as a source of antigen, indicating that it was autoreactive. T cell clones derived from this line had the L3T4 helper/inducer phenotype and reacted with self-Ia on syngeneic macrophages or B cell blasts. Cloned T cells were also stimulated by syngeneic accessory cells pretreated with the lysosomotropic agent chloroquine and by H-2 compatible, background gene disparate, accessory cells, suggesting that they were specific for self-Ia. After in vitro stimulation, the T cell clones secreted interleukin 2 (IL 2) and interferon-gamma (IFN-gamma), helped B cells in antibody production and activated macrophages for secretion of reactive oxygen metabolites.
Animals↗
Neuropsychological capacity of Prader-Willi children: general and specific aspects of impairment.
Although most Prader-Willi syndrome children perform in the mentally retarded ranges on standardized IQ tests, it is not known if their cognitive impairments are global in nature or if they exhibit a particular pattern of strengths and weaknesses in their psychological capacities. To examine this question, a cohort of children suffering from Prader-Willi syndrome was administered a battery of neuropsychological tests. The results indicated that, relative to other cognitive capacities assessed, particularly severe deficits were noted on tasks that involved information processing using the auditory modality. No differences in cognitive capacity were found between children with a number 15 chromosome defect and those with a normal karyotype configuration. Based on these initial findings, it appears that the clinical diagnosis of Prader-Willi syndrome is more important than a karyotype configuration in understanding these youngsters' manifest cognitive deficits.
Adolescent↗
Limiting dilution analysis of proliferating and helper T cells in the in vivo immune response to KLH: derepression of helper T cells at moderately increased frequencies.
While it is clear that some T cells have the capacity for almost indefinite proliferation in vitro, it is a controversial issue how much of this proliferative capacity is utilized by T cells in a response to antigen in vivo. In the framework of a strict clonal selection model the functional activities of normal and immune lymphocyte populations are essentially determined by the frequencies of antigen-specific cells which are clonally expanded after recognition of antigen. In contrast, our group has proposed a network model in which the more prominent effect of immunization is a release of antigen-specific T cells from a state of suppression (= derepression) which exists in the non-immune situation and which is generated through interactions between T cells involving their antigen-specific receptors. In this model, derepression is achieved by competition of antigen with the interactions among T cells through which suppression is exerted. To test our model, we analyze in this paper how much of the immune response to keyhole limpet hemocyanin (KLH) in draining lymph nodes is accounted for by an increase in the numbers of KLH-reactive T cells or by their derepression. To this end, we immunize mice subcutaneously with KLH in CFA. For a period of 14 days after immunization draining lymph nodes are removed, and the frequencies of KLH-reactive proliferating T cells and of KLH-reactive helper T cells determined. We find that proliferating T cells increase 5 to 8 fold in frequency from day 1 to 4 after immunization (approximately 1/30,000 to approximately 1/5000) and no evidence for suppression of these T cells in the non-immune situation can be obtained. In contrast, T helper cells are strongly suppressed in non-immune lymph nodes and become derepressed suddenly between days 3 and 4 following immunization. From day 0 to day 3 T helper cell frequencies are in the order of 1/14,000-1/38,000, then increase suddenly approximately 3-6 fold within 1 day from 1/16,000-1/8,000 to 1/3,000-1/5,000 with no further change until day 14. Thus, helper T cell immunity in draining lymph nodes appears to be generated by a combination of increased frequencies of specific T cells with their release from suppression. In addition, we have reasons to suspect that we overestimate the increase in T cell frequencies. We therefore think that derepression is a major factor in the response of T helper cells to antigen.
Animals↗
Hyperchloremic metabolic acidosis with high serum potassium in renal transplant recipients: a cyclosporine A associated side effect.
In four out of 23 renal transplant recipients treated with cyclosporine A (CyA) and prednisone, hyperchloremic metabolic acidosis with high serum potassium was detected. The patients with metabolic acidosis had a normal anion gap and they all had a urine pH less than 6.0. Plasma renin activity (PRA) was in the low normal range and serum aldosterone in the normal range. Following reduction of the CyA dose, serum bicarbonate increased, serum chloride and serum potassium fell. None of these parameters, however, became normal. Because of morphological changes and sustained reduced renal function, two patients were switched from CyA to azathioprine plus prednisone. Within two weeks after switching, serum bicarbonate, serum chloride, and serum potassium normalized. These data suggest, that CyA induces dose dependent hyperchloremic metabolic acidosis with high serum potassium in renal transplant recipients.
Acidosis↗
[Dosimetry studies of tissue equivalence of phantom materials for application in ortho-volt radiotherapy].
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Acrylates↗
[On the biosynthesis of calycanthine alkaloids].
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Alkaloids↗
[Experiences with capnometry in pediatric intensive care].
We investigated the correlation between arterial and end-tidal pCO2 in 17 children during intensive care. The indications for using capnometry were noninvasive monitoring of ventilation after cardiac surgery or during complicated course of illness or for control of intended hyperventilation. We found a good correlation between arterial and end-tidal pCO2 in the overall patient population (r = 0.82), but the relationship varied widely from patient to patient. There was only a weak correlation (r = 0.44) in pCO2 over 45 mm Hg. Hyperventilation could be identified in 64.2%, whereas hypoventilation was correctly indicated in only 23%.
Carbon Dioxide↗