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Biomedical subjects

C Müller

Publications and source records attributed to C Müller.

At least 343 records · Page 19Linked to original sources

Fas and Fas ligand in embryos and adult mice: ligand expression in several immune-privileged tissues and coexpression in adult tissues characterized by apoptotic cell turnover.

The cell surface receptor Fas (FasR, Apo-1, CD95) and its ligand (FasL) are mediators of apoptosis that have been shown to be implicated in the peripheral deletion of autoimmune cells, activation-induced T cell death, and one of the two major cytolytic pathways mediated by CD8+ cytolytic T cells. To gain further understanding of the Fas system., we have analyzed Fas and FasL expression during mouse development and in adult tissues. In developing mouse embryos, from 16.5 d onwards, Fas mRNA is detectable in distinct cell types of the developing sinus, thymus, lung, and liver, whereas FasL expression is restricted to submaxillary gland epithelial cells and the developing nervous system. Significant Fas and FasL expression were observed in several nonlymphoid cell types during embryogenesis, and generally Fas and FasL expression were not localized to characteristic sites of programmed cell death. In the adult mouse, RNase protection analysis revealed very wide expression of both Fas and FasL. Several tissues, including the thymus, lung, spleen, small intestine, large intestine, seminal vesicle, prostate, and uterus, clearly coexpress the two genes. Most tissues constitutively coexpressing Fas and FasL in the adult mouse are characterized by apoptotic cell turnover, and many of those expressing FasL are known to be immune privileged. It may be, therefore, that the Fas system is implicated in both the regulation of physiological cell turnover and the protection of particular tissues against potential lymphocyte-mediated damage.

Animals↗

Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomized trial.

OBJECTIVES: To assess the effect of three different alcohol withdrawal therapy regimens in traumatized chronic alcoholic patients with respect to the duration of mechanical ventilation and the frequency of pneumonia and cardiac disorders during their intensive care unit (ICU) stay. DESIGN: A prospective, randomized, blinded, controlled clinical trial. SETTING: A university hospital ICU. PATIENTS: Multiple-injured alcohol-dependent patients (n=180) transferred to the ICU after admission to the emergency room and operative management. A total of 180 patients were included in the study; however, 21 patients were excluded from the study after assignment. INTERVENTIONS: Patients who developed actual alcohol withdrawal syndrome were randomized to one of the following treatment regimens: flunitrazepam/clonidine (n=54); chlormethiazole/haloperidol (n=50); or flunitrazepam/haloperidol (n=55). The need for administration of medication was determined, using a validated measure of the severity of alcohol withdrawal (Revised Clinical Institute Withdrawal Assessment for Alcohol Scale). MEASUREMENTS AND MAIN RESULTS: The duration of mechanical ventilation and major intercurrent complications, such as pneumonia, sepsis, cardiac disorders, bleeding disorders, and death, were documented. Patients did not differ significantly between groups regarding age, Revised Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II score on admission. In all except four patients in the flunitrazepam/clonidine group, who continued to hallucinate, the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale decreased to <20 after initiation of therapy. ICU stay did not significantly differ between groups (p=.1669). However, mechanical ventilation was significantly prolonged in the chlormethiazole/haloperidol group (p=.0315) due to an increased frequency of pneumonia (p=.0414). Cardiac complications were significantly (p=.0047) increased in the flunitrazepam/clonidine group. CONCLUSIONS: There was some advantage in the flunitrazepam/clonidine regimen with respect to pneumonia and the necessity for mechanical ventilation. However, four (7%) patients had to be excluded from the study due to ongoing hallucinations during therapy. Also, cardiac complications were increased in this group. Thus, flunitrazepam/haloperidol should be preferred in patients with cardiac or pulmonary risk. Further studies are required to determine which therapy should be considered.

Adult↗

Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract.

BACKGROUND: The prevalence of chronic alcohol misuse in patients with oral, pharyngeal, laryngeal or esophageal carcinomas exceeds 60%. No data is available, to our knowledge, on the morbidity and mortality of chronic alcoholics in surgical intensive care units (ICU) following tumor resection. We investigated whether the subsequent ICU stay in chronic alcoholics following tumor resection was prolonged and whether the incidence of pneumonia and sepsis was increased. METHODS: 213 patients with carcinomas of the upper digestive tract were evaluated regarding their drinking habits. Chronic alcoholics met either the DSM-III-R criteria for alcohol abuse or dependence. Conventional laboratory markers and serum carbohydrate-deficient transferrin were determined preoperatively. Major intercurrent complications during ICU stay such as an alcohol withdrawal syndrome, pneumonia and sepsis as well as the frequency of death were documented. RESULTS: Patients did not differ significantly between groups regarding age or APACHE score on admission to the ICU.121 patients were diagnosed as being chronic alcoholics, 39 as being social drinkers and 61 as being non-alcoholics. In chronic alcoholics the frequency of death was significantly increased. Due to the increased incidence of pneumonia and sepsis the ICU stay was significantly prolonged in chronic alcoholics by approximately 8 days. CONCLUSIONS: The increased mortality and morbidity rate demonstrates that chronic alcoholics undergoing major tumor surgery have to be considered as high-risk patients during their postoperative ICU stay. Further studies are required with respect to the immuno-competence of chronic alcoholics and the prevention of alcohol withdrawal syndrome, pneumonia and sepsis in these patients.

APACHE↗

Evaluation of immunoassays for detection of antibodies to human herpesvirus 7.

An enzyme immunoassay (EIA), an immunoblot assay (IB), and an indirect immunofluorescence assay were developed for detection of human herpesvirus 7 (HHV-7) antibodies in human serum. Cross-absorption studies with EIA or IFA using HHV-7 and human herpesvirus 6 (HHV-6) antigens indicated that most human sera contain cross-reactive HHV-6 and HHV-7 antibodies and that the degree of cross-reactivity varies between individual serum specimens. Inhibition of homologous antibody activity by absorption with heterologous virus ranged from 0 to 57% by EIA. However, for every sample tested, absorption with homologous virus removed more activity than did heterologous virus. An 89-kDa protein was identified as an HHV-7-specific serologic marker by IB. Activity to this protein was not removed by absorption with HHV-6 antigen. Of the three assays, the EIA was the most sensitive (94%), while the IB was the most specific (94%). Approximately 80% of specimens collected from German adults and children older than 2 years were positive for HHV-7 antibodies by these assays.

Adolescent↗

Carbon catabolite repression of phenol degradation in Pseudomonas putida is mediated by the inhibition of the activator protein PhlR.

Enzymes involved in (methyl)phenol degradation of Pseudomonas putida H are encoded by the catabolic operon (phlA-L) on plasmid pPGH1. Transcription of this operon by the sigma54 (RpoN)-containing RNA polymerase is positively controlled by the gene product of the divergently transcribed phlR in response to the availability of the respective substrate. Additionally, phenol degradation is subject to carbon catabolite repression induced by organic acids (e.g., succinate, lactate, and acetate) or carbohydrates (e.g., glucose and gluconate). Analysis of lacZ fusion to the catabolic promoter and quantified primer extension experiments indicate that carbon catabolite repression also occurs at the transcriptional level of the catabolic operon. In this study, it is furthermore shown that carbon catabolite repression is a negative control. Titration of the postulated negative controlling factor was exclusively observed when extra copies of functional phlR gene were present in the cell. We therefore conclude that PhlR is the target and that carbon catabolite repression of phenol degradation occurs by interfering with the activating function of PhlR.

Bacterial Proteins↗

[Pruritometer 1: Portable measuring system for quantifying scratching as an objective measure of cholestatic pruritus].

Objective assessment of subjective symptoms such as pruritus always presents problems, which can often be resolved only indirectly. The objectification of pruritus was necessitated by a study on the efficacy of a serotonin antagonist used as treatment of cholestatic pruritus. In the present paper, a portable measuring system for the indirect objective assessment of pruritus via the quantification of scratching is described. A piezoelectric scratch-vibration sensor for attachment to the middle finger of the patient's dominant hand was developed. A sensor interface detects the scratching signals and generates pulses that are then summed in an adapted sports watch. The entire system-Pruritometer 1- is worn by the patient like a wrist watch, and is characterized by ease of handling. Acceptance by the patient is reported to be good. A statistically good correlation between measured (Pruritometer) and visually counted scratches was demonstrated. Pruritometer 2, which will enable scratch frequency and intensity distribution over time to be determined, is presently being developed.

Cholestasis, Intrahepatic↗

Prognostic significance of p53 expression, chromosome 17 copy number, and DNA ploidy in non-metastasized colorectal carcinomas (stages IB and II).

BACKGROUND AND METHODS: Paraffin-embedded tumor tissue from 101 non-metastasized colorectal adenocarcinomas (tumor stages IB and II--that is, pT2 and 3, pN0, M0) was investigated for p53 expression by immunohistology (IH) (moab DO1), chromosome 17 (#17) copy number by interphase cytogenetics using non-radioactive in situ hybridization (NISH) with a centromer-specific DNA probe (D17Z1), and DNA ploidy by flow cytometry (FCM). The aims of the study were 1) to test whether numerical #17 aberrations are involved in functional TP53 loss in locally confined colorectal carcinomas; 2) to search for correlations between aberrant p53 expression and #17 aberrations with DNA ploidy and histopathology; and 3) to test the prognostic significance of these factors. RESULTS: Sixty cases (59.4%) showed nuclear p53 expression IH (low-grade p53 accumulation (< 50%), n = 16 (15.8%); high-grade (> or = 50%), n = 44 (43.6%)). Nish showed #17 aneusomy in 46% of the carcinomas (34% deletions, 12% gains). In FCM analysis, 43% of the carcinomas were DNA non-diploid. p53 overexpression correlated statistically significantly with FCM non-diploidy (p = 0.013). Furthermore, #17 aneusomy also correlated with FCM non-diploidy (p = 0.001). However, there was no association between #17 status and p53 expression (IH). CONCLUSIONS: Our data suggest a role for the TP53 gene in the aneuploidization process. Numerical deletions of #17, however, were not associated with p53 immunoreactivity in the analyzed tumors. With regard to prognosis, the most important independent variable in stage IB/II colorectal carcinomas was tumor stage, followed by high-grade p53 expression of tumor cells; #17 aneusomy was an independent risk factor for tumor relapse/progression but not for survival. As alterations of the investigated variables were not found in all carcinomas under study, different pathogenetic pathways seem to exist in colorectal carcinogenesis.

Adenocarcinoma↗

Carbohydrate-deficient transferrin for identification of drug overdose patients at risk of an alcohol withdrawal syndrome.

BACKGROUND: Chronic alcohol abuse is frequent in patients admitted to the intensive care unit with acute drug overdose. During detoxification, an alcohol withdrawal syndrome may develop in patients with a history of chronic alcohol abuse. Withdrawal or delirium is associated with serious risks, necessitating early identification of patients at risk. Since the information obtained from the patients or their relatives on alcohol consumption is often unreliable, biochemical markers may be helpful. Carbohydrate deficient transferrin is considered a highly specific marker (reported maximum specificity 97%, sensitivity 40-85%) for identifying alcohol abuse. METHODS: In 20 patients with acute drug overdose and suspected alcohol abuse, carbohydrate deficient transferrin was determined by an immunoturbidimetric assay on admission to the intensive care unit. Eight of the patients had carbohydrate deficient transferrin levels above the "positive" threshold and nine in a suspicious range. A "false" negative carbohydrate deficient transferrin was found in three patients who were thought to have changed their drinking habits prior to hospitalization. A "positive" carbohydrate deficient transferrin test is assumed to be associated with ingestion of more than 60-80 g ethanol/d for a period of more than seven days. RESULTS: In all patients, clonidine (30-210 micrograms/h i.v.) was started. None developed delirium. Since alcohol addiction is frequently denied, determination of carbohydrate deficient transferrin may be useful for its early diagnosis but the sensitivity of this parameter requires further evaluation.

Alcohol Withdrawal Delirium↗

Tunneled, double lumen Broviac catheters are useful, efficient and safe in children undergoing peripheral blood progenitor cell harvesting and transplantation.

We prospectively evaluated performance, efficiency, safety and compliance of large-bore central venous catheters (Cook TPN; Cook (Switzerland) AG) introduced via saphenous veins in 32 children and infants elected to undergo peripheral blood progenitor cell (PBPC) harvesting and transplantation (PBPCT). With these catheters a flow rate (25-65 ml/min) adequate for leukapheresis was achieved in all patients. There were no important catheter-related complications during harvest. The total duration of catheter placement was 4569 days (median, 139 days; range, 8-268 days). During this period which included conditioning and PBPCT, we observed five mechanical complications and 12 septic episodes not necessarily catheter-related (0.11 and 0.26 events per 100 catheter days, respectively). All infections resolved after systemic antibiotic treatment. There was no exit or tunnel area infection, and no catheter had to be removed due to infection. Two catheters were replaced because of displacement. Tunneled double lumen Broviac catheters introduced via saphenous veins were not only efficient and safe, they were also well accepted by children and young adults undergoing PBPC harvesting and transplantation.

Adolescent↗

Monitoring of CMV infection: a comparison of PCR from whole blood, plasma-PCR, pp65-antigenemia and virus culture in patients after bone marrow transplantation.

Rapid, specific and sensitive methods are essential for early detection of CMV infection in patients after marrow transplantation. Thus, in a prospective study, PCR from whole blood, plasma-PCR, pp65-antigenemia and virus culture were used and compared in 20 consecutive marrow transplant recipients for early diagnosis of CMV infection and monitoring of antiviral therapy. Moreover, semi-quantification of the viral load in blood samples by PCR from whole blood or plasma and pp65-antigenemia was performed. Fifteen out of 20 patients were found to be CMV positive by PCR from whole blood, plasma-PCR and pp65-antigenemia, whereas only 9/20 developed culture-proven viremia and/or viruria. PCR from whole blood, plasma-PCR and pp65-antigenemia revealed identical results in 96 and discordant results in 13 of 109 blood samples (P < 0.01). The efficacy of antiviral therapy was monitored by semi-quantitative scoring of pp65-antigen-positive leukocytes and/or CMV-DNA levels in blood and plasma samples. Twelve of 13 patients were found to be CMV negative by all methods after 14 days of ganciclovir therapy. A good correlation of the semi-quantitative evaluation of the three assays was demonstrated. Thus, all three highly sensitive assays seem to be suitable for screening patients at risk for CMV infection and monitoring the efficacy of antiviral therapy.

Adolescent↗

Long-term follow-up in cerebral Whipple's disease.

OBJECTIVE: To evaluate the long-term outcome in patients with cerebral Whipple's disease. PATIENTS: We reviewed the literature and contacted authors who had reported on cerebral Whipple's disease within the last 10 years. Fifteen patients were evaluated, including one patient treated at our hospital and the one presented in this paper. The mean observation period was 41 +/- 37 months (minimum 1 month, maximum 120 months). RESULTS: Four patients had improved and were able to pursue an independent lifestyle, three patients had improved but are still dependent on help with simple activities of daily life, one patient was unchanged, and seven patients had died. Patients with initial penicillin alone had a worse prognosis than patients with initial penicillin plus streptomycin. CONCLUSION: Third generation cephalosporins have been shown to be beneficial in cerebral Whipple's disease, therefore initial antibiotic treatment of Whipple's disease should consist of ceftriaxone (instead of penicillin) combined with streptomycin. Since five of 12 patients (40%) treated with co-trimoxazole (trimethoprim plus sulphamethoxazole) did not respond, we conclude that the combination of trimethoprim and sulphamethoxazole does not prevent or cure central nervous system (CNS) involvement in all patients with Whipple's disease. If CNS relapse occurs during treatment with trimethoprim and sulphamethoxazole, oral third generation cephalosporins might be a useful alternative.

Anti-Bacterial Agents↗

[Differentiation and modification of compliance with reference to topical corticoid medication in patients with bronchial asthma].

Compliance of patients with bronchial asthma is often found to be insufficient. In a pilot study 66 patients with bronchial asthma underwent a teaching program in the setting of an in-patient rehabilitation treatment. The differentiation of this in-patient group showed that fear of negative side-effects and the doubt about the effectiveness--according to the period of illness, extent of bronchial restrictions and period of life--influence the quantity of corticoid taken by the patients. To improve the effectiveness of such teaching programs these aspects therefore have to be taken into consideration.

Administration, Inhalation↗

[Severe protracted cholestasis after general anesthesia in a patient with Alagille syndrome].

A 27-year-old female patient with partial Alagille's syndrome (hypoplasia of the intrahepatic bile ducts, typical facial dysmorphism and skeletal anomalies) developed a marked cholestasis (total bilirubin 59 mg/dl), decrease of liver synthesis tests and ascites four weeks after gynecological surgery with general anesthesia involving propofol, isoflurane and nitrous oxide. Slow recovery could be achieved under treatment with ursodeoxycholic acid, spironolactone and substitution of fat-soluble vitamins A, D, E and K. Four months after admission the ascites had disappeared, liver synthesis had increased and the total bilirubin level had dropped to 3.8 mg/dl. Since all other possible causes were excluded during the hospital stay, the prolonged episode of cholestasis in this patient is best explained by the preceding general anesthesia with propofol which is known to be metabolized in the liver and impedes hepatic cytochrome P450 and hepatic blood flow.

Adult↗

NF-M (chicken C/EBP beta) induces eosinophilic differentiation and apoptosis in a hematopoietic progenitor cell line.

CAAT/enhancer binding proteins (C/EBPs) are transcriptional activators implicated in the differentiation processes of various cell lineages. We have shown earlier that NF-M, the chicken homolog of C/EBP beta, is specifically expressed in myelomonocytic and eosinophilic cells of the hematopoietic system. To investigate the role of NF-M in hematopoietic cell lineage commitment, we constructed a conditional form of the protein by fusing it to the hormone binding domain of the human estrogen receptor. This construct was stably expressed in a multipotent progenitor cell line transformed by the Myb-Ets oncoprotein. We report here that both NF-M-dependent promoter constructs and resident genes could be activated by addition of beta-estradiol to the NF-M-estrogen receptor expressing progenitors. At the same time, we observed a down-regulation of progenitor-specific surface markers and the up-regulation of differentiation markers restricted to the eosinophil and myeloid lineages. In addition to the onset of differentiation, cell death was induced with typical apoptotic features. Our results suggest that NF-M plays an important role in commitment along the eosinophil lineage and in the induction of apoptosis.

Animals↗