Biomedical subjects
Publications and source records attributed to D Berger.
This study is based on the in-vitro analysis of the normal and pathological colon smooth muscle contraction. Two different methods, supported by computer analysis, are presented. This approach will probably help the physician and the surgeon to better understand the physiopathology of some characteristical diseases, such as Hirschsprung's disease.
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Vascular tumors of the breast are extremely rare, and the majority are malignant. In this report, the presentation of a diffuse, benign, cystic, vascular tumor that histologically was angiomatosis of the breast is described. The clinical presentation, magnetic resonance imaging (MRI) appearance, and histologic features of this rare lesion are reviewed. This case is of particular interest because the tumor recurred during pregnancy and underwent massive enlargement despite negative hormone receptor values. Angiomatosis is prone to local recurrence, so complete excision with histologically negative margins is the treatment of choice.
This study of compliance was performed to determine whether a medically indigent population with breast carcinoma that has been neglected is an appropriate group for inclusion in an aggressive combined treatment program. After incisional biopsy, 28 locally advanced breast cancer (LABC) patients received two cycles of cytoxan, Adriamycin, 5-Fluorouracil, and tamoxifen (CAFT) followed by a simple mastectomy and level I axillary dissection. After surgery, patients received four additional cycles of CAFT alternating with three cycles of 15 Gy to the chest wall and regional lymphatics. Compliance was defined as overall compliance, the percentage of patients completing the protocol as described; and appointment compliance, the ratio between treatments or appointments attended versus those scheduled. Overall compliance was 75% (21 of 28 patients). The total number of appointments scheduled was 1054 (mean, 37 +/- 2), and the total attended was 965 (mean, 34 +/- 3), giving an appointment compliance rate of 91.7%. Compliance did not vary significantly with age, marital status, nationality, the presence of complications, or delay to diagnosis. Compliance did decrease significantly with time. There was 100% overall compliance at 2 months, 82% at 6 months, and 75% at 1 year. We conclude that although our patients had neglected their disease and were medically indigent, they were highly motivated patients once in therapy. This suggests that complex treatment regimens are feasible as well as effective for the treatment of LABC.
Recent reports of stratospheric ozone depletion have prompted concerns about the levels of solar ultraviolet radiation that reach the earth's surface. Since 1974 a network of ground-level monitoring stations in the United States has tracked measurements of biologically effective ultraviolet radiation (UVB, 290 to 330 nanometers). The fact that no increases of UVB have been detected at ground levels from 1974 to 1985 suggests that meteorological, climatic, and environmental factors in the troposphere may play a greater role in attenuating UVB radiation than was previously suspected.
A newly developed modification of the limulus amebocyte lysate test for quantification of endotoxin levels in blood is described. The chromogenic peptide carbobenzoxy-Gly-Gly-Arg-4-methyl-cumarinyl-7-amid proved to be most suitable. The liberated fluorescent dye is diazotized with N(1-naphtyl-)-ethylen-diamin-dihydrochloride. Using this statistically proved reliable and sensitive test, endotoxin serum levels of healthy persons and patients undergoing major surgical treatment were compared. In the postoperative phase endotoxin serum levels up to 0.5 ng/ml can be detected without clinical signs of septicemia. Healthy persons show endotoxin serum levels up to 0.08 ng/ml. In rats no difference of endotoxin serum levels was detected in the portal vein, and in arterial and venous blood. So a physiological endotoxin resorption from the intestine followed by a clearance during the liver passage seems to be doubtful in this species.
Data obtained by in vitro experiments concerning the binding kinetics of the transferrin-endotoxin interactions are provided. The separation of protein-bound and free tritiated endotoxin of E. coli O 111:B4 is achieved by a simple precipitation method using ethanol. The main features of this reaction are the velocity of the saturation--saturation is reached after 2-3 min--and the requirement of divalent cations. EDTA (ethylenediaminetetraacetic acid) strongly inhibits the binding reaction of endotoxin to transferrin. The specificity of this interaction as well as the physiological importance can be demonstrated by the replacement of the radioactively labelled lipopolysaccharide preparation of E. coli 0 111:B4, by non-radioactive preparations of Salmonella minnesota, Serratia marcescens, E. coli 0 55:B5 and E. coli 0 111:B4. The described ethanol precipitation procedure for separating protein-bound and free endotoxin was applied to a commercially available immunoglobulin preparation. Although this preparation is known to exhibit high antibody titers against the lipid A moiety of lipopolysaccharides, no specific binding with the intact lipopolysaccharide can be found.
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In the present paper the ability of Gc-globulin and transferrin to bind endotoxin of Escherichia coli 0 111: B 4 is demonstrated. This conclusion is based on four lines of evidence. By affinity chromatography using lipopolysaccharide of E. coli 0 111: B 4 two endotoxin-binding proteins of serum were identified, showing an apparent molecular weight of 77,000 and 51,000, respectively. If serum samples preincubated with the tritiated endotoxin form have undergone isoelectric focusing under non-denaturing conditions one radioactive peak appears which coincides with the precipitate obtained by immunoelectrophoresis against anti-human Gc-globulin and anti-human transferrin. Radioimmunoprecipitation experiments of serum showed that tritiated endotoxin of E. coli 0 111: B 4 was only found in the precipitate obtained with anti-Gc-globulin, antitransferrin, and polyvalent antiserum against human serum. By isoelectric focusing of purified proteins 3H-lipopolysaccharide of E. coli 0 111: B 4 was only found associated with human Gc-globulin and transferrin.
An evaluation was made of 106 surgical patients with Gram-negative septic shock, both for clinical criteria as well as the biochemical mediators endotoxin, prostaglandin F2 alpha, prostaglandin I2 (prostacyclin), and thromboxane. These data were correlated to various defined shock phases, functional data of vital organs, and clinical outcome. Patients underwent invasive organ function monitoring and the usual laboratory tests of intensive care. Prostaglandins and thromboxane were measured radioimmunologically, endotoxin by the limulus amebocyte lysate test. Endotoxin proved to be a more accurate predictor of severe sepsis than did positive blood cultures. Endotoxin as well as prostaglandins and thromboxane are predominantly released in early shock phases, appearing in plasma concentrations, which correlate with the severity of organ failure. Sepsis-induced respiratory failure coincides with a deterioration of pulmonary prostaglandin inactivation, which contributes to the release mechanism. High systemic prostacyclin activity benefits the patients' organ functions and clinical outcomes, while a predominance of thromboxane seems to effect the opposite. Transpulmonary-thromboxane gradients correlate significantly with pulmonary hypertension in the early phases of septic shock.
The unstable bladder, or bladder-sphincter dysfunction, is the result of unbalanced maturation and physiological control of bladder function in the young child. It is characterised by the persistence of the reflex-bladder stage typical in the newborn, and in the older child can be seen as either a bladder-filling problem or as an emptying problem. It can be responsible for enuresis, urinary tract infections and squatting, as well as the more serious morphological charges of the upper urinary tract such as reflux uropathy and pyelonephritis. This article aims to present the aetiopathology to describe the clinical characteristics of the syndrome and suggest a diagnostic and therapeutic approach to the problem.
This paper addresses the nationwide need for comprehensive health care services directed toward adolescents, outlining a multidisciplinary team program designed to provide such services. The national problem of teenage pregnancy is discussed, and the multidisciplinary team's success with family planning counseling is described. The authors strongly encourage the development of more school- or community-based clinics based on a comprehensive health care team model.
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The treatment of portal hypertension in children by portosystemic shunt or Vosschulte dissection-ligature is not definitive. Recurrent oesophageal varices or high gastrointestinal bleeding occur on a medium-term and long-term basis. We are investigating endoscopic sclerotherapy as a therapeutic alternative. The aim of this prospective study is to analyse the treatment and follow-up of 7 children with prehepatic portal hypertension who have undergone sclerotherapy, using a flexible endoscope. The first results at short-term and medium-term follow-up are encouraging. The authors discuss the technique, complications and emergency use of sclerotherapy.
Iontophoresis (iontotherapy) is sometimes employed to permit epidermal medication. Corticosteroids have been recently one of the most frequently employed, although the literature reports no scientific study demonstrating its effectiveness. This work reports our experimentation on steroid iontophoresis both in vitro and in vivo, to determine whether steroids pass through the skin. Using paper electrophoresis, we first studied the electrophoretic mobility of six water-soluble corticosteroids commercially available in Switzerland. Then an experimental model with two cylinders, one containing a steroid solution and the other filled with buffer solution separated by human skins was submitted to ionization. The in-vivo experimentation consisted in a study of steroid iontotherapy in four rabbits and in 188 patients. Our in-vitro and in-vivo studies failed to demonstrate the transcutaneous migration of corticosteroids.
Manometric and electromyographic analysis of anorectal function in terminal gastrointestinal tract malformations is a technique which gives an insight into the specific pathophysiology of anorectal malformations and can be used to follow the clinical evolution and to analyse the maturation phenomena of the lowered colon. It includes the study of spontaneous sigmorecto-anal activity associated with a way of examining the anorectal response to stimuli (adaptation, reaction, relaxation reflexes of the internal anal sphincter, rectal compliance, continence reaction, measure of critical volume and lastly the anorectal profile). This study can be completed by electromyography of striated anorectal sphincter structures. Some values for normal anorectal continence and partial or complete incontinence can be calculated after review of the literature.
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The analysis of 19 esophageal and pulmonary scintiscans performed with a non-reabsorbable radioactive tracer shows that this is a simple and efficient way of detecting the presence of a GER or a bronchial aspiration of gastric contents in children. This examination proves to be more sensitive, with a lower amount of radiation necessary, than the radiological gastroesophagography. It is less invasive and takes place under more physiological conditions. It is especially useful when symptoms lead one to suspect a syndrome of GER with aspiration.