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Biomedical subjects

D Berger

Publications and source records attributed to D Berger.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Duodenum-preserving pancreatic head resection--a standard method in chronic pancreatitis].

In patients with chronic pancreatitis the inflammatory process in the pancreatic head is frequently the pacemaker of the disease. In these cases an inflammatory tumor develops which leads to local complications in half of the patients. Duodenum-preserving pancreatic head resection, contrary to procedures used in the past, offers the possibility to preserve stomach, duodenum, biliary tree, and the insulin secretory capacity. Duodenum-preserving pancreatic head resection is a subtotal resection of the pancreatic head. In a series of 380 patients the hospital mortality rate was 0.8%, the frequency of reoperation 5.3%, and the median hospitalisation time 13.9 days. The early postoperative glucose metabolism was deteriorated in 2% and improved in 9% of cases. After a median follow-up time of 6 years, 88% of the patients were completely painfree or suffered pain rarely. Sixty-three percent were gainfully employed; the late mortality was 8.9%. Only 10% of the patients had further bouts of pancreatitis. The decisive advantage of duodenum-preserving pancreatic head resection over Kausch-Whipple resection is preservation of the endocrine pancreatic function and of neighbouring organs.

Blood Glucose↗
PubMed1997

Prognostic relevance of C-terminal Mdm2 detection is enhanced by p53 positivity in soft tissue sarcomas.

We examined the clinical value of immunohistochemical (IHC) Mdm2 detection by an N-terminal (IF2) and a C-terminal (19E3) binding monoclonal antibody (Ab) in soft tissue sarcomas (STSs) with regard to the p53 status. Therefore, we investigated a cohort of 198 patients with STSs of six entities with known p53 IHC by using a multivariate Cox regression model to determine the prognostic value of Mdm2 staining. Only positivity with the 19E3 Ab correlated multivariately significantly with survival (RR = 2.32, p = 0.0035). We stratified the C-terminal Mdm2 staining (19E3) according to p53 IHC (DO-1) and found patients could be divided into three groups with an increasing risk: (a) patients with Mdm2 (19E3)-negative as well as p53 (DO-1)-negative tumors, (b) patients with tumors that were either Mdm2 (19E3) or p53 (DO-1) positive, and (c) patients with tumors that were Mdm2 (19E3) as well as p53 (DO-1) positive. Positive staining for both Mdm2 and p53 meant a very poor prognosis with a relative risk of 4.63 (p = 0.00001). This points to the possibility that--in addition to the p53-dependent pathway--Mdm2 could have an effect through a p53-independent pathway. Thus, our results indicate that C-terminal Mdm2 staining (19E3) constitutes an independent prognostic marker in STS.

Adolescent↗
PubMed1997

Time-scale of interleukin-6, myeloid related proteins (MRP), C reactive protein (CRP), and endotoxin plasma levels during the postoperative acute phase reaction.

During goitre surgery (25 patients) and after major abdominal surgery (52 patients), we studied the plasma levels of endotoxin, interleukin-6 (IL-6), C reactive protein (CRP), and the so called myeloid-related proteins (MRP), MRP8, MRP14, and the heterocomplex of both single proteins, MRP8/MRP14 in three intervals: pre-, intra-, and postoperative. We observed that CRP levels began to increase on the first postoperative day, reaching a maximum on day 2 (median levels of 185 mg/L after major surgery and 77 mg/L after goitre surgery). IL-6 levels peaked at the end of the operation, remaining elevated for 6 h following abdominal surgery (299 pg/mL) and peaked on day 1 after goitre surgery (63 pg/mL). An increase in MRP8/MRP14 levels began toward the end of abdominal surgery, and maximum levels were recorded until 5 days after the operation (5,695 micrograms/L). Plasma levels were significantly elevated 2 and 6 h after minor surgery (3,619 micrograms/L), while no changes were observed in the plasma levels of MRP8 and MRP14. Evidence of significant endotoxemia was found after the induction of anesthesia in the abdominal surgery group (.13 endotoxin units (EU)/mL) and after skin incision (.07 EU/mL) in the thyroid surgery group. The observed time sequence, starting with the release of bacterial products at an early stage, followed by the secondary stimulation of factors inherent to the acute phase led us to conclude that certain bacterial compounds, probably deriving from the gastrointestinal tract, trigger the postoperative acute phase reaction and are responsible for the activation of monocytes/macrophages and granulocytes.

Abdomen↗
PubMed1997

Adhesive proteins and the hematogenous spread of cancer.

The metastatic spread of cancer is a complex and multistep process characterized by a number of biological steps which include the hematogenous and lymphatic arrest and adhesion of circulating tumor cells in the vascular bed, invasion of tumor cells through the basement membrane, and growth of new tumor colonies in the organ parenchyma. In this brief review we describe the role of platelets, the hemostatic system, adhesive proteins and their putative receptors in the hematogenous dissemination of cancer. The major adhesive proteins postulated to play a role in tumor arrest in the vascular bed are thrombospondin-1 (TSP-1), laminin, fibronectin and hyaluronan-proteoglycans. The major tumor and vascular receptors mediating these adhesive interactions are the CSVTCG-specific TSP-1 receptor, the 67-kD laminin receptor, the alpha v beta 3 vitronectin/TSP-1/fibronectin receptor, and CD44 hyaluronan receptor. The discovery of the involvement of these adhesive proteins and receptors in the metastatic spread of cancer as well as components of the hemostatic system offers unique opportunities for the development of antimetastasis therapies for the treatment of cancer.

Animals↗
PubMed1997

A comparison of Japanese and American psychiatrists' attitudes towards patients wishing to die in the general hospital.

BACKGROUND: The attitudes of the psychiatrists in Japan and the US were compared in order to investigate their ideas on whether patients in general medical hospitals who have a desire to die should be allowed to do so or be assisted in this regard, and whether they require psychiatric evaluation and intervention, and the cultural influences on these attitudes. METHODS: Japanese and American general hospital psychiatrists' attitudes towards the reasonability of suicide, physician-assisted suicide, and removal of life supports under various medical and psychosocial situations were compared. Seventy-two American and 62 Japanese psychiatrists' data were collected using the Suicidal Attitudes Inventory. RESULTS: The majority of both American and Japanese psychiatrists agreed that there may be times when suicidal ideation or completed suicide in med-surg patients could be reasonable. Significantly more Japanese psychiatrists responded with some agreement to the reasonability of suicide when one is unable to fulfill social role expectations, and had more concern about causing suicidal ideation by informing terminal patients of their diagnosis. CONCLUSIONS: The results indicate that psychiatrists' attitudes towards the relationship of psychopathology with suicidal ideation, the effect of depression, and other cultural factors on the desire to die in the medically ill are issues that need better clarification among both the medical profession as well as within society. Looking at how other societies handle these matters may help to understand one's own approach to them.

Adult↗
PubMed1997

Personality disorders in psoriasis.

Rubino and Zanna (5) have responded to our comments (1) on their report (4) on the association of personality disorders with psoriasis and have presented data comparing the personality characteristics of psoriasis patients with those in urticaria patients. The problems that remain with their methodology are that dental controls may not be equivalent to dermatologic conditions, and in the urticaria study, no data on premorbid functioning were provided to differentiate state vs trait phenomena, and they did not control for duration of illness.

Dental Anxiety↗
PubMed1997

Detection of p53 autoantibodies in sera of gastric cancer patients and their prognostic relevance.

BACKGROUND: Changes in the p53 gene product can be immunogenic and enable the formation of p53 serum antibodies (p53ab), detectable in patients with different cancer types. So far, there have been no reports describing the detectability of p53ab in gastric cancer patients. METHODS: We investigated the presence of p53ab and their clinical relevance in a cohort of 74 gastric cancer patients, using an enzyme-linked immunosorbent assay system. RESULTS: In our investigation 20.3% of all patients (15 of 74) and 46.9% of the patients with immunohistochemically (IHC) p53-positive tumors (15 of 32) showed detectable p53ab in serum. All p53ab-positive patients had IHC p53-positive tumors. We have found a significant correlation of p53ab with a higher tumor stage (P = 0.002) and also with a poor prognosis of survival (P = 0.04). CONCLUSION: We have shown that in gastric cancer patients p53ab are also detectable and that p53ab positivity is a predictor of an unfavorable prognosis.

Adult↗
PubMed1997

Endoscopic management of ureteroceles in children.

OBJECTIVE: Treatment of ureteroceles in children varies according to the anatomicopathological form and the choice of the surgical team. This study tries to determine the exact value of the endoscopic management of ureteroceles in children. METHODS: Between 1987 and 1993, 11 ureteroceles in 10 children were treated by endoscopic incision: 7 intravesical ureteroceles (4 single system and 3 duplex system) and 4 duplex-system ectopic ureteroceles. The procedure consists of a tiny transversal incision at the lower and median aspects of the ureterocele. RESULTS: The dilation of the upper urinary tract disappeared or decreased in all cases of intravesical ureteroceles and in half the cases of ectopic ureteroceles. Endoscopic incision of the ureterocele led to a vesicoureteral reflux in the associated ureter in 6 cases: 54.5% (43% of the intravesical ureteroceles, 75% of the ectopic ureteroceles). Following endoscopic treatment, no further surgery was required in 5 of the 7 cases with intravesical ureteroceles (71.5%), while every case of ectopic ureterocele needed a further operation (lower tract surgery in 3 cases, upper tract surgery in 1 case). CONCLUSIONS: Endoscopic incision of ureteroceles is a simple and quick procedure which allows obstruction to be removed and the dilation of the upper urinary tract and its corresponding kidney function to be improved, particularly in the neonate. The endoscopic management of ureteroceles may in itself suffice, without necessity of further surgery. These favorable results can more readily be seen in cases of intravesical ureterocele than in those of ectopic ureterocele.

Child↗
PubMed1997

[Infection without infection focus--clinical relevance of bacterial translocation].

The passage of bacteria, fungi, and bacterial products through the gut wall, which is called microbial translocation, is an experimentally well-defined process occurring during burn injury, multiple trauma, and septic diseases. The translocation of viable bacteria could be demonstrated in humans as a sporadic event, but despite accumulating evidence the clinical relevance remains to be elucidated. The same fact is true for the translocation of bacterial products such as endotoxin. Although a large body of evidence supports the hypothesis that endotoxin of gut origin may play a pathophysiologically important role, general acceptance is still lacking because some clinical studies provide disappointing results due to unrecognized methodological problems.

Animals↗
PubMed1996

Frequent occurrence of p53 mutations in rhabdomyosarcoma and leiomyosarcoma, but not in fibrosarcoma and malignant neural tumors.

We have analyzed soft-tissue sarcomas (STS) molecularly for mutations in the tumor-suppressor gene p53 and immunohisto-chemically for expression of p53 and mdm2 proteins. In this study, tumor samples from 3 groups of soft-tissue sarcomas, i.e., fibrosarcomas, myogenic sarcomas and malignant neural tumors (MNT), were investigated. The methods applied encompass immunohistochemistry on 198 tumor samples using p53 antibodies (DO-1 and DO-7) and an mdm2 antibody (IF-2). Out of these, 100 samples were subjected to non-radioactive PCR-SSCP-sequencing analysis. Immunohistochemical detection rate for p53 (range of 57% to 67%) and for mdm2 proteins (range of 19 to 44%) was similar in all 3 groups. In higher tumor grades, an increased rate of immunopositivity was found for p53 but not for mdm2. Investigation of p53 mutational status revealed 6 mutations in myogenic sarcomas but none in malignant neural tumors or fibrosarcomas, suggesting different roles of p53 in the 3 STS groups. Interestingly, a G-->A transition in codon 245 (a CpG site) was found in 3 myogenic sarcomas. Our results and those of others suggest p53 codon 245 as a mutational hotspot in sarcomas, as recognized in carcinomas.

Base Sequence↗
PubMed1996

Increased expression of CD40 ligand on systemic lupus erythematosus lymphocytes.

The specificity of T cell help for B cell activation and differentiation is maintained by the brief expression on the T cell surface, following T cell receptor-mediated triggering, of CD40 ligand (CD40L). Interaction of T helper (Th) cell CD40L with B cell CD40 induces B cell activation, cell surface expression of activation antigens, proliferation, and initiation of immunoglobulin isotype switch. We predicted that in patients with systemic lupus erythematosus (SLE), in whom Th cell-dependent production of autoantibodies results in immune complex-mediated tissue damage, CD40L expression might be augmented, prolonged, or abnormally regulated. Baseline expression of CD40L was increased in some SLE patients studied, when compared with control subjects. While Th cells from normal subjects (n = 14) and rheumatic disease control patients (n = 9) showed maximal expression of CD40L, after in vitro activation with phorbol myristate acetate (PMA) and ionomycin, at 6 h of culture with diminished levels observed at 24 and 48 h, Th cells from SLE patients (n = 19) maintained high level cell surface expression of CD40L through 24 and 48 h of culture. The prolonged expression of CD40L was functionally significant, as 24 h-activated SLE T cells, when cocultured with target B cells, induced greater B cell surface CD80 (B7-1) expression than did 24 h-activated normal T cells. These results document impaired regulation of CD40L expression in SLE T cells and identify an important potential target for therapy in this systemic autoimmune disease.

Adult↗
PubMed1996

Evaluation of endotoxiuria for diagnosis of urinary tract infection after major surgical procedures.

In 148 patients after major surgical procedures urinary endotoxin levels were determined and compared with bacteriological results. The study was designed as a screening study. Urine samples were collected once by suprapubic or transurethral catheters. In a first series of 49 patients urine bacteriology was positive (mainly, Gram-negative rods were found) in 3 cases. However, endotoxin determination was positive in these 3 patients and in a further 10 patients receiving antibiotic therapy for other reasons. Therefore, the following 99 patients were studied also by urinalysis by reagent strips for leukocytes and nitrite. In the second series, 12 urine cultures positive for bacteria were observed. Eleven samples were also endotoxin positive. Five more patients were endotoxin positive and had pathological but unspecific reagent strip results. These patients were treated with antibiotics for other reasons. Patients with candida found in the urine culture (n = 5) were endotoxin negative. Thus, endotoxin determination in urine obtained by suprapubic or transurethral catheters proved to be a very sensitive method for diagnosis of bacterial contamination, even during antibiotic treatment.

Adult↗
PubMed1996

Coordinate control of growth and cytokeratin 13 expression by retinoic acid.

Retinoic acid (RA) modulates the growth and differentiation of various normal and malignant cells. These effects are most likely mediated by changes in gene expression. Genes whose expression is modulated by RA may be useful as markers of growth responsiveness to retinoids. Using differential cDNA cloning we identified 10 genes regulated by RA in the head and neck squamous cell carcinoma cell line MDA886Ln. Keratin (K) 13 gene expression was the gene expression most related to the degree of sensitivity of growth to RA, as K13 was not expressed in a series of RA-resistant cell lines. Our data suggest that low K13 expression may be mechanistically related to resistance to RA-induced growth inhibition.

Carcinoma, Squamous Cell↗
PubMed1996

Predominance of the metastatic phenotype in hybrids formed by fusion of mouse and human melanoma clones.

The fusion of mouse and human melanoma cells that were tumorigenic but had different metastatic capabilities resulted in hybrids that were metastatic when injected intravenously or subcutaneously into nude mice, regardless of whether it was the mouse or the human melanoma clone that was metastatic. The H7 hybrid line, formed by fusing murine nonmetastatic K1735 C19 cells with human metastatic A375 C15 cells retained high metastatic potential over more than 50 sub-culture passages, suggesting that the dominant metastatic phenotype in these hybrid cells was stable. Using fluorescent in situ hybridization (FISH), human chromosome 17 was consistently identified as the predominant human chromosome in the majority of H7 cells tested between passages 20 and 60. Western blot analysis showed that the hybrid cells expressed human nm23 protein, indicating that at least one gene on the human chromosome 17 was functional. Immunocytochemistry and immunoprecipitation showed that the metastatic A375 C15 and H7 cells expressed p53 protein, but that the nonmetastatic K1735 C19 melanoma cells did not. Sequencing the human p53 gene in A375 C15N and H7 showed mutations in exon 7. Using a bioassay technique, we showed that K1735 C19 cells can spread from subcutaneous tumors to the lungs of nude mice yet fail to form metastases. With the addition of human chromosome 17 from A375 C15 cells, which carries a mutant p53 gene, the cells readily formed lung metastases. In this melanoma hybrid, a mutant p53 gene appears to confer a survival advantage on cells arrested in the lungs of nude mice and thus contributes to the growth of metastatic cells.

Animals↗