Biomedical subjects
Publications and source records attributed to C Schmid.
We report a case of phenytoin induced lymph node enlargement with changes in both the lymph nodes and bone marrow suggestive of T-cell non-Hodgkin's lymphoma. The condition resolved after phenytoin withdrawal and the patient has no evidence of disease on bone marrow biopsy 15 months later.
Supraventricular bradycardia is an occasional complication after orthotopic heart transplantation. This study was undertaken to analyze the effectiveness of orciprenaline to increase heart rate and thus to avoid pacemaker implantation. Between January 1989 and December 1990, 109 patients underwent orthotopic heart transplantation at our institution, of whom 80 patients were included in the study (66 male, 14 female; age 9 to 62 years). Within the early postoperative period (< 14 days) 29 of 80 patients (36%) developed supraventricular bradycardia. Two patients underwent immediate pacemaker implantation, 27 patients were treated with oral orciprenaline (4-6 x 20 mg). 9 of the 27 patients (33%) showed an increase of the heart rate from 57 to 76/min, which remained sufficiently high after discontinuation of the drug. 18 patients (67%) did not respond to the drug (mean heart rate 45/min) and were scheduled for pacemaker implantation, which was performed in all except two. The period of orciprenaline application in both subsets of patients were comparable (postoperative day after HTX = POD 4.6-19.6 vs POD 5.9-23.2, Student's t-test: not significant). During the follow-up period of 6 months, none of the patients developed further bradycardia. However, 11 out the 18 patients with pacemaker implantation (61%) regained sufficient supraventricular rhythm (mean heart rate 96/min). In summary, orciprenaline application is able to prevent pacemaker implantation in one third of patients with sinus dysrhythmia after heart transplantation.
We describe the clinical presentation, morphology, immunophenotypic features and molecular biology of seven cases of conjunctival lymphoid infiltration. In five cases there was either immunophenotypic or molecular evidence of B-cell lymphoma. Each of these cases showed the morphological, immunophenotypic and molecular feature of low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type. The findings suggest that most conjunctival lymphomas are of this type and explains their uniformly favourable prognosis.
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A 47 year old man presented with hoarseness and chest pain found to be due to proliferative syphilitic aortitis. The case is unusual as the syphilitic aortitis caused a mediastinal mass without affecting the lumen of the aorta.
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BACKGROUND AND PURPOSE: In this study we analyzed the value of ultrasound examination for diagnosis of vertebral artery dissection. METHODS: The vertebrobasilar arterial system was assessed in 14 patients using transcranial and extracranial pulsed-wave Doppler and duplex sonography. RESULTS: The dissections were verified by angiography (in 1 patient), magnetic resonance imaging (in 5), or both (in 8). The dissected segments were atlantoaxial (V-3) in 6, V-3 and intertransverse (V-2) in 3, V-3 and intracranial (V-4) in 3, and V-2 in 2 patients. Extracranial and transcranial Doppler examination of the atlas loop, involved in 12 patients, showed absent flow signal in 5, low bidirectional flow signal in 1, and poststenotic low blood flow velocities in 3 patients. Seven of these patients had high-grade stenosis or occlusion. The stenotic segment with increased flow signal could be identified directly in 2 patients. Duplex examination of the intertransverse segment confirmed absent flow in 4 patients, making technically insufficient examination unlikely. In the 2 patients with directly detected stenosis, duplex examination showed low flow velocities before the stenosis. The combined use of extracranial and transcranial Doppler and duplex sonography increases the diagnostic yield to detect vertebral artery pathology. If any abnormal sonographic finding was considered, the yield was 86%; relying only on definitively abnormal findings (absent flow signal, severely reduced vertebral artery blood flow velocities, no diastolic flow, bidirectional flow, and a stenosis signal), the yield was 64%. CONCLUSIONS: In most cases, there is no pathognomonic ultrasound finding for vertebral artery dissection. However, if a patient presents with suggestive symptoms, ultrasound may corroborate the clinical suspicion and aid in the decision regarding early anticoagulant treatment. A definite diagnosis can be made noninvasively when magnetic resonance imaging demonstrates hematoma in the vessel wall. Angiography yields additional information such as nature of underlying vascular disease, site and extent of dissection, intracranial extension, and presence of pseudoaneurysm.
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We have recently cloned cDNAs encoding human insulin-like growth factor binding proteins (IGFBP)-4, -5 and -6 and have now expressed these BPs in yeast as ubiquitin (Ub)-IGFBP fusion proteins. Western ligand blotting with 125I-IGF II under nonreducing conditions of recombinant human (rh) IGFBP-containing yeast lysates revealed specific binding bands for IGFBP-4, -5, and -6 at apparent molecular masses of 24-26, 30-32, and 24-26 kDa, respectively, indicating expression and processing of the fusion proteins. HPLC purified rhIGFBPs had virtually the same amino acid composition, amino acid number, and NH2-terminal sequences as the native BPs. Rabbit antiserum directed against each rhIGFBP-4, -5 and -6 reacted specifically with the respective rhIGFBP as well as with the native human counterpart and displayed very low cross-reactivity with other IGFBPs. Except for the affinity of rhIGFBP-6 for IGF I (Ka = 8.5 x 10(8) M-1), the affinity constants of the three IGFBPs for IGF I and II lie between 1.7 and 3.3 x 10(10) M-1. When present in excess, rhIGFBP-4, -5, and -6 inhibited IGF I- and II-stimulated DNA and glycogen synthesis in human osteoblastic cells, although rh-IGFBP-6 had only a weak inhibitory effect on IGF I in agreement with its relatively lower IGF I affinity constant.
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BACKGROUND: Human cryoglobulinemia is sometimes associated with glomerulonephritis (GN) due to deposition of cryoglobulins (cryos). To see whether human cryos can induce GN in mice and to study time-related changes of glomerular lesions and possible factors of cryos' nephritogenicity, we developed an experimental passive model of cryoglobulinemic GN. EXPERIMENTAL DESIGN: Two cryos IgMk-IgG from 2 patients with active GN (OLD and SOR), 2 cryos IgMk-IgG (TAC and GRO) and 1 IgM lambda (CHI) from 3 patients without GN were purified, solubilized at 37 degrees C and injected intravenously into BALB/c mice, 4 mg, twice a day. To study the possible factors of cryo nephritogenicity, we analyzed: (a) the presence, amount, and size of complexed IgMk-IgG at 37 degrees C by fast flow liquid chromatography; (b) the Cc1 or Lc1 subclass of rheumatoid factors; (c) the isoelectric points of the IgMks; (d) The proportion of IgG subclasses in cryos. RESULTS: On day 1 from the beginning of intravenous injections, cryos OLD had induced mesangial deposits of human IgM, human IgG, mouse C3 and mesangial hypercellularity. On day 2, phagocytizing cells were found along with massive endoluminal and subendothelial deposits of IgM, IgG, and C3. On day 6, perivascular infiltrates of mononuclear cells were also seen. Cryos SOR induced a similar but milder form of GN. After administration of purified OLD IgMk, OLD IgG, GRO IgMk or GRO IgG, only OLD IgMk was deposited in the mesangium. Analysis of all the cryos revealed that: the amount of complexed IgMk-IgG at 37 degrees C was always less than 1% of cryos; Cc1 and Lc1 idiotypes were not related to the nephritogenicity of cryos, the isoelectric points of IgMks were 4.5 to 5.5 and IgG1 was the prevalent subclass. CONCLUSIONS: Data demonstrate that human cryos from patients with GN can induce GN in mice that resembles the corresponding human pathology. The affinity of IgMk for glomeruli and the unexpectedly small amounts of IgMk-IgG complexes at 37 degrees C suggest that there is a role of in situ binding in nephritogenicity which is independent of the isoelectric point, rheumatoid factor idiotype, or IgG subclass.
Fulminant pulmonary embolism associated with cardiac arrest has an extremely high mortality. The feasibility of pulmonary embolectomy initiated during resuscitation is still under discussion. Between January 1975 and October 1992, embolectomy was performed in 34 patients, 21 to 79 years of age. Diagnosis was established primarily by indirect parameters (medical history, ECG, blood gas analyses, Swan-Ganz catheter in 22 cases). Only in 12 instances, imaging techniques as angiography, ventilation perfusion mismatch, and transesophageal echocardiography were performed. Fifteen patients did not require resuscitation (group A); 6 had to be resuscitated and underwent surgery after reestablishing circulation with catecholamines (group B); 13 patients were connected to extracorporeal circulation during continuous cardiopulmonary resuscitation (30 to 210 minutes) (group C). Embolectomy was performed using extracorporeal circulation with the heart beating (n = 8), or fibrillating (n = 15), or using cardioplegia (n = 11). Twenty-two patients received a caval clip or ligature at the end of the procedure. Fifteen patients (44%) died early postoperatively. The mortality rates for groups A, B, and C were 33%, 66% and 46%, respectively. Nine patients died of right heart failure, 4 of brain death, and 2 of septical complications. Of the surviving patients, only one had ischemic brain damage. In two cases a recurrent pulmonary embolism occurred after a follow-up of 16 years (mean follow-up 4.9 years). We conclude, that even with subtotal obstruction of the pulmonary artery, effective cardiopulmonary resuscitation with maintenance of uncompromised brain function is possible. In emergency situations, the decision to operate may be based only on clinical features without imaging diagnostic procedures.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: Cystic enlargement of the extrahepatic bile duct system is a rare abnormal finding. A congenital origin is usually supposed; however, the pathogenesis is unknown. We report on our experience with extrahepatic bile duct cysts with special regard to cause, treatment, and recurrent disease. METHODS: From 1976 to 1991, 13 patients, 35 to 74 years of age, were treated for extrahepatic bile duct cysts. Seven patients had previously undergone cholecystectomy. Two patients were admitted because of recurrent disease; neither had undergone curative resection. RESULTS: In 11 patients a biliojejunal anastomosis with a Roux-en-Y was created after cyst resection; one patient underwent a diverticular stalk resection with end-to-end anastomosis of the choledochal duct. After a mean follow-up of 68 months eight of 10 patients were alive, two of whom complained about cholangitis. Recurrent diffuse dilatation of the remaining choledochus developed in one patient; one other patient died of cholangiocellular carcinoma 2 years after operation. CONCLUSIONS: In patients who had undergone previous cholecystectomy or with recurrent disease an acquired malformation cannot be excluded. Surgical treatment is always indicated because of imminent complications and should aim at complete resection of cystic tissue. Periodic postoperative evaluation is necessary to detect recurrent disease and malignant transformation.
The article describes a medium-term, i.e., 4-6 months, inpatient withdrawal programme for alcoholic men in a specialized clinic. A holistic therapy approach is applied, equally including the multiple etiologic aspects of alcoholism as well as underscoring the need for comprehensive diagnosis and individualized treatment in therapeutic respects. The therapeutic activities of a multidisciplinary team are set out, comprising medical doctors, social workers, psychologists, and Occupational Therapists. The treatment concept is based on a systemic/family-therapy view of the symptoms present. The focus hence is not confined to tracing possibilities for behavioural change to the alcoholic individual, but significant others are equally involved in the therapeutic process in order that the individual may newly define and experience his environment and frame of reference. In this process, abstinencé is a major prerequisite for self-reliant, contented life planning and future coping.
Sleep related breathing disorders influence the structure of sleep by considerably modifying the ratios of the individual sleep stages. The sleep analyses carried out by polysomnography in the diagnosis of sleep related breathing disorders have so far been evaluated manually according to the criteria of Rechtschaffen and Kales, since automatic systems do not permit standardised evaluation as yet. Automatic sleep analyses via SAC, however, has been developed further in recent years and has widened its scope and efficiency. It is now possible to perform a comprehensive sleep analysis via SAC by means of modified criteria after Rechtschaffen and Kales. The SAC determines individual curves in the EEG and EOG and includes in addition to the EEG parameters an automatic apnoea detection as well as detailed breathing and oxygen saturation analyses. The Sleep Analysis Computer (SAC) records 15 parameters (2 EEG, 2 EOG, 2 EMG, ECG, NAF, thoracic and abdominal breathing curves, oxygen saturation, body posture, optionally blood pressure = RR, CPAP etc.). This means that all the parameters required for diagnosing sleep related breathing disorders as well as their differential diagnosis can be determined. Within the framework of a blood pressure study, 16 patients (average 45.5 SD 4.6 years) were subjected to SAC measurement in addition to conventional PSG. The computer recordings were evaluated according to apnoea index, the form of the apnoea and the oxygen saturation desaturations. The evaluation yielded the following pattern: 4 patients with AI < 10, 8 patients with AI between 10 and 20, 4 patients with AI > 20. Obstructive apnoeas were seen in 6 patients, mixed apnoeas in 8 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
GTP cyclohydrolase I of Escherichia coli has been purified from a recombinant bacterial strain. The enzyme was crystallized from 0.6 M-sodium citrate and from 0.8 M-sodium/potassium phosphate, respectively. Crystals grown in citrate showed X-ray diffraction extending to a resolution better than 3 A. The space group was P2(1) with cell dimensions a = 204.8 A, b = 210.1 A, c = 72.2 A, alpha = gamma = 90 degrees and beta = 95.8 degrees.
A 35-year-old man reported persistent exertional dyspnoea and pressure sensation over the left chest for the last six weeks. On auscultation there were diminished breath sounds over the right base. Chest X-ray demonstrated a 10 cm large ventral paracardiac shadow on the right. Computed tomography suggested a hernia of the foramen of Morgagni; persisting symptoms indicated a laparotomy. This revealed an opening of about 1.5 cm in the right substernocostal triangle through which the entire greater omentum had herniated into the thorax. The omentum was repositioned and the hernial defect closed by direct suture. The postoperative course was without complication and the patient was discharged after seven days.
The insulin-like growth factor binding protein (IGFBP) family comprises six structurally distinct, but highly homologous proteins. They have been identified in serum and other biological fluids, tissue extracts, and cell culture media. We have recently cloned cDNAs encoding human IGFBP-4, -5, and -6 and have now expressed these BPs in yeast as ubiquitin (Ub)-IGFBP fusion proteins. Western ligand blotting with 125I-IGF II under nonreducing conditions of recombinant human (rh) IGFBP-containing yeast lysates revealed specific binding bands for IGFBP-4, -5, and -6 at apparent molecular masses of 24-26, 30-32, and 24-26 kDa, respectively, indicating processing of the fusion proteins. High-performance liquid chromatography-purified rhIGFBPs had virually the same amino acid composition, amino acid number, and NH2-terminal sequences as the native BPs. Except for the affinity of rhIGFBP-6 for IGF I (Ka = 8.5 x 10(8) M-1), the affinity constants of the three IGFBPs for IGF I and II lie between 1.7 and 3.3 x 10(10) M-1, i.e. 25-100 times higher than the IGF I and II affinities of the type I IGF receptor. When present in excess, rhIGFBP-4, -5, and -6 inhibited IGF I- and II-stimulated DNA and glycogen synthesis in human osteoblastic cells, but rhIGFBP-6 had only a weak inhibitory effect on IGF I in agreement with its relatively lower IGF I affinity constant. The results of this study show that the primary effect of the three rhIGFBPs is the attenuation of IGF activity and suggest that IGFBPs contribute to the control of IGF-mediated cell growth and metabolism.