Prevention, treatment, and resuscitation of cerebral ischemia.
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Anesthetics, General↗
Biomedical subjects
C Glaser
Publications and source records attributed to C Glaser.
[CT and MRI of small intestine interposition after oropharyngeal tumor resection].
Freely transplanted, microvascularly anastomosed jejunal patches can be used to cover soft tissue defects in the oral cavity or oropharynx after the resection of malignant tumors. Even a patch without complications or alteration from tumor recurrence is morphologically diverse. Therefore it is difficult to distinguish between malignant and benign alterations, and knowledge of the possible morphological spectrum and the significance of an alteration is of practical interest. Computed tomography (CT; n = 30) and magnetic resonance imaging (MRI; n = 13) were used for follow-up examinations in patients who had an operative reconstruction with a jejunal patch. Three parts of a patch were differentiated with both imaging modalities: the region of the anastomosis, the mesenterial fatty tissue and the intestinal wall. The morphology of the patches correlated with clinical findings in the following cases. The patches were identified satisfactorily by CT and MRI. The appearance of patches without complications was influenced by a variable degree of fibrosis and by persistent intestinal folds. Recurrent tumors only infiltrated the margins of the patches. Destructive alterations in the patches were always less severe than those in the original orofacial soft tissue. Postoperative follow-up examinations with CT and MRI are particularly important when tumor recurrences spread under a patch, since these tumors are invisible in the clinical examinations. CT was advantageous in demonstrating osseous alterations and showed less loss of image quality in patients for whom the implantation of multiple metallic hardware during the operation had been necessary.
Adult↗
Thyroid gland surgery in an endemic region.
To assess the incidence, indications, and complications of (reoperative) thyroid gland surgery in an endemic region, we have retrospectively analyzed 1318 patients operated on between 1983 and 1994. There were 166 reoperations (13.5%). In comparison to the primary operation the indication for reoperation showed an increased rate of premalignant and malignant tumors (+16%) and a decreased rate of hyperthyroid disorders (-30%). The largest group operated on had benign multinodular goiters, with the same rate of indication for primary (57.4%) and secondary (57.8%) surgery. Permanent recurrent laryngeal nerve palsy rate following primary operation occurred at rates of 1.7% (1983-1990) and 0.7% (1991-1994) and for secondary operation 3.5% (1983-1990) and 5.6% (1991-1994), respectively. The change in recurrent nerve palsy rate in the later years was due to a more extensive resection policy at the primary operation and a more liberal approach to reoperative surgery. The high rate of reoperation for benign goiters (13%) and the new data of goitrogenesis have therefore directed our policy to more extensive resection of the thyroid tissue at the initial operation, increasing the rate of lobectomy from 27% (1982-1990) to > 90% (1991-1994) and at the same time lowering morbidity. Extensive resection of nodular tissue during the initial operation safely reduces the incidence of recurrent goiter and subsequently reduces the rate of reoperation and eliminates the high risk of morbidity associated with reoperative thyroid surgery. The indications for reoperation should be strict, and when unavoidable a modified lateral approach may be helpful.
Goiter, Endemic↗
Horseshoe Le Fort I osteotomy in combination with endosteal implants--a median-term follow-up study.
Fourteen patients with Class VI resorption of the maxilla were treated with horseshoe Le Fort I osteotomy. In 11 cases, the procedure was followed by the placement of endosteal implants. In six patients, simultaneous placement of implants was carried out, while in five patients this was done in a second procedure. Ten patients wore their implant-supported dentures. In one patient, 5/8 implants were lost due to nonintegration. Three patients lost one implant each. The total number of implants placed was 76, and the survival rate of the implants was 88.1%. In the one-step procedure (n = 42), the survival rate was 84.8%; in the two-step procedure (n = 34), 92.3%. In comparison of the one-step to the two-step procedure, there was no statistically significant difference (P > 0.11) between the amount of marginal peri-implant bone loss and the condition of the peri-implant soft tissues as measured 2 years after implantation.
Adult↗
Bone metastasis with superimposed osteomyelitis in prostate cancer.
The following case of a male patient with a history of prostate cancer suffering from pain and swelling in the right mandibular area illustrates the well-known diagnostic problem of a superinfected tumor. Orthopan tomography and CT showed no defects in bone structure or smooth tissue. Whole-body bone scanning showed increased tracer uptake in the mandibular bone and in several other locations in the skeletal system. Antigranulocyte immunoscintigraphy showed increased uptake over the right mandible, whereas the other metastatic sites were visualized as cold spots. A second CT scan depicted a sclerotic lesion with surrounding periostal reaction and soft-tissue swelling and was interpreted as osteomyelitis. Therefore, clinical symptoms, bone scanning, antigranulocyte immunoscintigraphy and follow-up CT resulted in a diagnosis of osteomyelitis, although open needle biopsy revealed the lesion to be prostate cancer metastasis with massive leukocytic invasion.
Antibodies, Monoclonal↗
[Experiences and results in management of mandibular fractures with the modified Krenkel lag screw--a retrospective study].
The stable osteosynthesis of mandibular fractures with the modified lag screw (Krenkel) has proven superior to conventional lag screws in theoretical models and clinical use. Compared to osteosynthesis with plate systems, the lag screw technique is more difficult to learn for the unexperienced, but the reduction of fragments under compression with a lag screw and the stabilisation of lower jaw rotation with an additional short miniplate in our experience has proven successful in clinical use.
Adolescent↗
Utility of technetium-99m-sestamibi to assess osseous tumor spread.
We report the staging results and the surgical outcome of a male patient with squamous-cell carcinoma in the floor of the mouth and a bone SPECT scan suggestive of local tumor infiltration of the mandible. Additional 99mTc-sestamibi SPECT imaging of the primary tumor and superimposing of both studies excluded osseous tumor spread and less extensive surgery was performed. Pathohistological examination confirmed the scintigraphic results and indicated a nonspecific periostal reaction as the cause of the positive bone scan. Nevertheless, a high-resolution camera and careful superimposition of both studies is mandatory if the differential diagnosis of an osseous tumor spread of a malignant tumor in the floor of the mouth and possibly less extensive surgery is at stake.
Carcinoma, Squamous Cell↗
Images in clinical medicine. Ehrlichiosis.
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Adolescent↗
Infection with a babesia-like organism in northern California.
BACKGROUND: Human babesiosis is a tick-transmitted zoonosis associated with two protozoa of the family Piroplasmorida: Babesia microti (in the United States) and B. divergens (in Europe). Recently, infection with an unusual babesia-like piroplasm (designated WA1) was described in a patient from Washington State. We studied four patients in California who were identified as being infected with a similar protozoal parasite. All four patients had undergone splenectomy, three because of trauma and one because of Hodgkin's disease. Two of the patients had complicated courses, and one died. METHODS: Piroplasm-specific nuclear small-subunit ribosomal DNA was recovered from the blood of the four patients by amplification with the polymerase chain reaction. The genetic sequences were compared with those of other known piroplasm species. Indirect immunofluorescent-antibody testing of serum from the four patients and from other potentially exposed persons was performed with WA1 and babesia antigens. RESULTS: Genetic sequence analysis showed that the organisms from all four patients were nearly identical. Phylogenic analysis showed that this strain is more closely related to a known canine pathogen (B. gibsoni) and to theileria species than to some members of the genus babesia. Serum from three of the patients was reactive to WA1 but not to B. microti antigen. Serologic testing showed WA1-antibody seroprevalence rates of 16 percent (8 of 51 persons at risk) and 3.5 percent (4 of 115) in two geographically distinct areas of northern California. CONCLUSIONS: A newly identified babesia-like organism causes infections in humans in the western United States. The clinical spectrum associated with infection with this protozoan ranges from asymptomatic infection or influenza-like illness to fulminant, fatal disease.
Adult↗
Recombinant soluble human thrombomodulin: a randomized, blinded assessment of prevention of venous thrombosis and effects on hemostatic parameters in a rat model.
UNLABELLED: Thrombomodulin is an endothelial surface receptor that binds thrombin and accelerates the activation of protein C. We compared the effects of a recombinant thrombomodulin analog (TME), recombinant hirudin (r-HIR), heparin sodium (HEP), and normal saline (Control) on thrombus formation, activated partial thromboplastin time (APTT), thrombin time (TT), platelet aggregation and tail transection bleeding time (BT) in a rat model of vena cava thrombosis. RESULTS: TME, r-HIR and HEP prevented venous thrombosis in this model in a dose-dependent manner. At the dose required to reduce vena cava thrombosis by 50% (ED50), TME did not prolong the APTT or TT as did HEP and r-HIR. Platelet aggregation in response to thrombin was not effected by TME but was inhibited by both r-HIR and HEP. BT did not differentiate the agents tested. CONCLUSION: TME inhibited venous thrombosis in a rat vena cava model with less effect on hemostatic variables than HEP or r-HIR.
Animals↗
Domains of colicin M involved in uptake and activity.
Colicin M inhibits murein biosynthesis by interfering with bactoprenyl phosphate carrier regeneration. It belongs to the group B colicins the uptake of which through the outer membrane depends on the TonB, ExbB and ExbD proteins. These colicins contain a sequence, called the TonB box, which has been implicated in transport via TonB. Point mutations were introduced by PCR into the TonB box of the structural gene for colicin M, cma, resulting in derivatives that no longer killed cells. Mutations in the tonB gene suppressed, in an allele-specific manner, some of the cma mutations, suggesting that interaction of colicin M with TonB may be required for colicin M uptake. Among the hydroxylamine-generated colicin M-inactive cma mutants was one which carried cysteine in place of arginine at position 115. This colicin derivative still bound to the FhuA receptor and killed cells when translocated across the outer membrane by osmotic shock treatment. It apparently represents a new type of transport-deficient colicin M. Additional hydroxylamine-generated inactive derivatives of colicin M carried mutations centered on residues 193-197 and 223-252. Since these did not kill osmotically shocked cells the mutations must be located in a region which is important for colicin M activity. It is concluded that the TonB box at the N-terminal end of colicin M must be involved in colicin uptake via TonB across the outer membrane and that the C-terminal portion of the molecule is likely to contain the activity domain.
Alleles↗
Newborn with hydrops and a rash.
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Edema↗
Intravenous recombinant soluble human thrombomodulin prevents venous thrombosis in a rat model.
Thrombomodulin is an endothelial surface thrombin receptor. Thrombin bound to thrombomodulin loses all procoagulant activity and instead activates the protein C anticoagulant pathway. We developed a recombinant thrombomodulin analog and compared the effects of recombinant thrombomodulin (100 micrograms/ea), saline (controls), recombinant hirudin (1.0 mg/kg), and heparin (100 units/kg) on thrombus formation, activated partial thromboplastin time, and tail transection bleeding time in a rat model of stasis-induced venous thrombosis. Results showed that thrombus was detected in the vena cava in six of the six rats treated with saline solution, in zero of the six rats treated with recombinant thrombomodulin (p less than 0.05), in one of six rats treated with recombinant hirudin (p less than 0.05), and in zero of six rats treated with heparin (p less than 0.05). The activated partial thromboplastin time in rats receiving recombinant thrombomodulin was slightly longer than controls (22 +/- 8 vs 37 +/- 6, p less than 0.05). The bleeding times in rats receiving recombinant thrombomodulin were approximately twice as long as controls (215 +/- 68 vs 545 +/- 173, p = 0.037). In all rats treated with recombinant hirudin or heparin, activated partial thromboplastin times were greater than 120 seconds and bleeding times were greater than 1200 seconds. We conclude that recombinant thrombomodulin inhibits venous thrombosis in a rat model with less prolongation of activated partial thromboplastin time and bleeding time than heparin or hirudin.
Animals↗
A comparative clinical study of two anticalculus dentifrices for efficacy in the inhibition and removal of surface stain and calculus.
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Aluminum Oxide↗
Evaluation of ketamine, ketamine-xylazine and ketamine-diazepam anesthesia in the ferret.
Ketamine, ketamine-xylazine, and ketamine-diazepam were evaluated clinically in 15 ferrets, and safe dosage was determined for each. All of the three regimens provided excellent immobilization. However, muscle rigidity and incomplete analgesia were noted in ketamine alone and in ketamine-diazepam respectively. It was concluded that 25 mg/kg ketamine and 2 mg/kg xylazine intramuscularly provided acceptable analgesia, muscle relaxation, duration and smooth recovery, although cardiac arrhythmias were a concern and require careful observation.
Anesthesia, General↗
Can alpha-1-protease inhibitor be used in replacement therapy?
We propose that alpha-1-protease inhibitor (alpha 1 PI) can assume a major and beneficial role in preventing emphysema in alpha 1 PI-deficient individuals, and may also prove of value in the treatment of adult respiratory distress syndrome (ARDS). alpha 1 PI has a single, unusual disulfide bond that consists of a cysteine residue in the peptide chain covalently bound to a free amino acid cysteine. The linkage can be broken by reductants without adversely affecting the stability or the inhibitory activities of the protein. As a result of this property, alpha 1 PI can be effectively separated in solution from many other plasma proteins by salting out the contaminants in the presence of strong reductants. We have applied the technique of reductive-salting out, coupled with more conventional DEAE-anion exchange chromatography to isolate alpha 1 PI from Cohn Fraction IV-1, a relatively unused side product in the worldwide production of albumin and immunoglobulins. Furthermore, we have demonstrated that the product can be effectively pasteurized in the presence of various stabilizing additives. The necessary ingredients now exist for extensive clinical studies in the years ahead.
Chemical Phenomena↗
Carbohydrate-binding proteins from plant cell walls and their possible involvement in extension growth.
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Animals↗
[Pathologic glenohumeral stress distribution in calcific tendinosis of the supraspinatus].
AIM: Based on hypothesis that calcific tendonitis of the supraspinatus tendon (CTSSP) could be associated with glenohumeral imbalance, glenohumeral stress distribution was analyzed. METHODS: 26 patient shoulders with CTSSP, unsuccessfully treated by non-operative measures, were examined. A group of 26 macroscopically normal shoulder specimens served as controls. Analysis of glenohumeral stress distribution was indirect evaluating glenoid subchondral bone mineralization by computed tomography osteoabsorptiometry. Density distribution of glenoid subchondral bone mineralization and the position of the two most frequent density maxima were analyzed. RESULTS: Patterns of subchondral mineralization and position of the anterior density maximum were significantly different between both groups. CTSSP mostly presented with a monocentric, anteriorly increased mineralization indicative for a regional increase of stress. The inferior shift of the anterior density maximum demonstrates a parallel shift of glenohumeral stress distribution. CONCLUSION: Mineralization patterns indicate that glenohumeral stress distribution is not physiologic in CTSSP. Moreover, it is comparable with glenohumeral stress distribution as observed in atraumatic antero-inferior glenohumeral instability. Relevance of this observation should be proven for etiology of CTSSP.
Calcification, Physiologic↗