Search PubMed⌕ Search

Biomedical subjects

E Wolner

Publications and source records attributed to E Wolner.

At least 217 records · Page 12Linked to original sources

Carcinogen-specific mutations in the p53 tumor suppressor gene in lung cancer.

Mutations of the p53 tumor suppressor gene, whose encoded protein is one of the chief regulators of the cell cycle, are proving to be the most common genetic alteration in human cancer. Point mutations have been detected in numerous human solid tumors. The types of point mutations in the p53 gene vary considerably in different kinds of human cancers, suggesting that specific etiologic agents are responsible for typical kinds and sites of mutations in the p53 gene. This study reports the detection of two unusual p53 mutations in a series of patients with lung cancer. The first case showed a one-base pair deletion at the end of exon 8, which is rarely affected by mutations, leading to a frameshift involving the following intron 8, exon 9, and intron 9. The second case exhibited two point mutations in codon 273, both either localized in the same codon on one allele or each mutation localized on a different allele in codon 273. Interestingly, the two mutations can be attributed to different mechanisms of base substitution. This is the first report of this kind. Because of evidence that the nature and site of p53 mutations reflect not only the mutagens involved in tumorigenesis but also the capacity for malignant transformation, the characterization of mutations of the p53 gene may provide a basis for assessing further risk factors, as well as for estimating prognosis in patients with lung cancer.

Adenocarcinoma↗

Circulatory support with shock due to acute myocardial infarction.

Cardiogenic shock after acute myocardial infarction develops according to the amount of lost myocardium, function of remote myocardium, and the phenomenon of infarct expansion. Patients treated with mechanical support alone, without additional measures, have a mortality rate of 80%, the same as patients treated medically. Emergency angioplasty and emergency coronary artery bypass grafting can reduce mortality in certain subsets of patients to 40%. Patients with more severe shock and secondary organ dysfunction may be treated with mechanical bridging to transplantation with survival rates varying between 45% and 76%. Percutaneous support systems may be used to resuscitate a patient or to temporize, allowing time to perform diagnostic studies to determine if the patient is suitable for revascularization or heart transplantation. Intravenous enoximone may improve cardiac function as well and thus allow better decision making for further therapy.

Aged↗

Successful lung transplantation in a long-term ventilator-dependent patient.

Ventilator dependence has been postulated to be a major contraindication for successful lung transplantation. We describe the case of a 44-year-old female patient mechanically ventilated for 10 months after adult respiratory distress syndrome. After a program of physical training the patient underwent successful bilateral sequential lung transplantation. Six months postoperatively she is in good physical condition and is able to carry out the activities of normal daily living. We conclude that in selected patients long-term mechanical ventilatory support is not a contraindication for lung transplantation.

Activities of Daily Living↗

Effects of interleukin-1, -2, -4, -6, interferon-gamma and granulocyte/macrophage colony stimulating factor on human vascular endothelial cells.

Human vascular endothelial cells (HUVEC) exhibit various immunological functions, i.e. expression of HLA class-II antigens after incubation with IFN-gamma or antigen presenting function. It has also been reported that HUVEC are able to produce IL-1, IL-6, GM-CSF and immunologically active cleavage products of arachidonic acid. In our study we investigated whether various cytokines, namely IL-1, IL-2, IL-6, GM-CSF and IFN-gamma, do alter the proliferative capacity of HUVEC, the production of van Willebrandt factor (vWF) and the expression of MHC class-II antigens. HUVEC were prepared by the collagenase digestion of human umbilical veins. Monolayers of cells were incubated with cytokines in different concentrations for 24 and 48 h. IFN-gamma inhibits the HUVEC [3H]thymidine uptake in a dose-dependent manner. Suppression of proliferation (40.1%) could be observed after 24 h incubation with 100 U IFN-gamma/ml. IL-1 was a more effective inhibitor of HUVEC proliferation (54% at 10 U/ml and 24 h incubation and 48.4% after 48 h) than IFN-gamma. IL-6 and GM-CSF showed an increasing effect on proliferation with 226% and 151% of the control group, respectively. IFN-gamma after an incubation period of 12 h and IL-1 after 24 h reduced the vWF content by about 30%. Bright MHC class-II expression was induced only by IFN-gamma. In conclusion, some of the immunoregulative cytokines might play an important role in the control of HUVEC proliferation.

Cell Division↗

Pulmonary autograft valve replacement in the dilated and asymmetric aortic root.

Pulmonary autograft aortic valve replacement is the only technique for implantation of a biologic, vital and thus nondegenerating valve. The technique of root replacement overcomes problems of asymmetric aortic roots and reduces the risk of malalignment, but bears the risk of dilatation. We have performed pulmonary autograft aortic root replacement in 20 patients (mean age 22 years, range 5-38). Twelve presented with aortic incompetence, 3 with stenosis and 5 with combined defects. Initially roots were implanted just supraannularly with two running suture lines. As the neo-aortic roots gradually dilated, we started to implant autografts intraannulary, but still one valve dilated and aortic incompetence (AI) increased from grade I to II. Consequently the remaining aortic wall was wrapped around the new root and the composite subsequently was reinforced by a circular absorbable mesh. In addition, the aorta and pulmonary valve were exactly sized and the aortic root was reduced by commissuroplasty stitches up to 6 mm in diameter in seven cases. The ventricular size decreased in all patients 10 days after surgery, the left ventricular end-diastolic diameters (LVEDD) from 58 +/- 12 to 52 +/- 10 mm (P = 0.0002; paired t-test) and left ventricular end-systolic diameter (LVESD) from 41 +/- 12 to 36 +/- 10 mm (P = 0.008), but the contractility did not change significantly (fractional shortening from 31 +/- 9% to 30 +/- 9%). The diameter of the new aortic ring increased for the supraannular position but size matching and the intraannular valve position reduced the new ring size significantly (P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Closed circuit perfusion of an isolated rabbit lung. A new model for the evaluation of preservation quality of stored lungs.

The comparison of different preservation methods in lung transplantation demands a well standardized and reproducible animal model. The aim of this study was to establish as in vitro model in which the oxygenation capacity of the lung can be investigated over an extended period of time. Heart-lung blocks from 6 New Zealand white rabbits were harvested, the pulmonary artery and the left ventricle cannulated and the lungs perfused with whole rabbit blood by means of a roller pump and ventilated with room air. A dialyser was installed into the closed circuit perfusion for continuous deoxygenation of the oxygen-saturated blood gained from the left ventricle. Throughout the stable perfusion period the average arterial and venous partial oxygen pressure (pO2) levels were 105.8 +/- 15.5 mmHg and 55.2 +/- 6.2, respectively (P < 0.05). The average peak airway pressure steadily increased from 10.7 +/- 1.2 mmHg at the start of reperfusion to 21 +/- 14.4 mmHg after 180 minutes (P = NS). With this experimental setting it is possible to maintain stable conditions (i.e. constant venous and arterial blood gases) for at least 180 minutes. It is therefore feasible to compare the influences of different preservation methods on the quality of lung function.

Animals↗

Six-year follow-up after heart valve replacement with the Edwards Duromedics bileaflet prosthesis.

The Duromedics Edwards valve (DE) was designed with a self-irrigating hinge mechanism to reduce the rate of thromboembolic complications. This report presents a prospective follow-up of patients after valve replacement with this prosthesis in a university hospital. Five hundred seven patients had DE prostheses implanted in the aortic (n = 268), mitral (n = 183) or aortic and mitral positions (n = 56). The perioperative mortality was 6.9%. Follow-up was 98% complete, comprising 2009 patient years for a mean follow-up of 48 months: (range 27-84). The actuarial freedom from complications is calculated as follows (linearized rates in parentheses): late mortality 81.0 +/- 2.3% (3.4%/patient year), thromboembolism 93.5 +/- 1.5% (1.1%/patient year), anticoagulation-related hemorrhage 89.5 +/- 2.0% (1.9%/patient year), prosthetic valve endocarditis 96.0 +/- 1.2% (0.7%/patient year), valve-related mortality 93 +/- 1.8% (1.5%/patient year), valve failure 89 +/- 2.0% (2%/patient year), treatment failure 88.0 +/- 2.0% (2.2%/patient year) and all valve-related morbidity and mortality 74.0 +/- 2.8% (5.3%/patient year). Two events of leaflet escape were observed in the study group (0.09%/patient year). Both patients were reoperated successfully. Mechanical hemolysis was subclinical in all cases. The DE shows a complication rate comparable to other modern mechanical valve prostheses. After solving the problem of durability, reconsideration of this valve is worthwhile due to its low risk of thromboembolic complications.

Aortic Valve↗

New developments in the isolated working heart: a comparison of neonatal, immature, and adult rabbits after sixty minutes of ischemia in respect to hemodynamic and biochemical parameters.

Hemodynamic and biochemical changes were studied on 36 white ELCO-rabbits, seven adult older than 150 days, seven immatures between 21 and 27 days, and seven neonatals between 7 and 14 days. Five supplementary hearts of each age group served for preischemic biochemical values. Protection during 60 min of global ischemia was provided by topical cooling and selective coronary perfusion with Bretschneider cardioplegia (8 degrees C). A comparison between pre- and postischemic results showed decreases in coronary flow in the adult (p < 0.004), aortic flow (p < 0.04), cardiac output (p < 0.02), and stroke volume (p < 0.02) in the neonate. The preservation of ATP and CP was sufficient in the adult and immature myocardium, whereas a significant decrease in neonatal ATP was found (p < 0.01). According to these findings we consider immature myocardium to be more resistant against ischemia than the two other age groups. The apparatus used is a development of the conventional working heart, but combines a physiological flow-pressure relation, with instruments guaranteeing high accuracy, devices for drug application, and fits for different sizes of hearts. Therefore, this new approach promises to be of clinical relevance for investigations on the improvement of myocardial protection in both adults and children.

Adenosine Triphosphate↗

Clinical experience with minimally invasive thoracic surgery.

From October 1991 to June 1992 video-endoscopic lung surgery was applied in a total of 109 patients. In the first case a pulmonary cyst measuring 15 x 18 cm was resected. In 21 patients lung nodules were exstirpated by means of wedge resection. Moreover, metastasectomies, open lung biopsies, parietal pleurectomies, resections of bullae, and decortications, as well as 3 lower-lobe lobectomies were performed using video-endoscopic procedures. Closure of lung parenchyma was carried out using the 3 cm Endo-GIA stapler (Autosuture). In none of the patients were we forced to enlarge the intervention to a thoracotomy because of technical problems. Indications, operative technique and results are presented. This new technique offers all the known advantages of minimally invasive surgery to patients requiring thoracic surgery.

Anesthesia, General↗

Central nervous system function after cardiopulmonary bypass.

In a prospective study, an elderly group of patients (n = 63, 47 male, 16 female, age 40-65 years) was examined before and after open-heart surgery under cardiopulmonary bypass: postoperatively, 19 patients (30%) showed no clinical neuropsychiatric symptoms, whereas in 35 patients (56%) mild or transient neurological signs and in nine (14%) severe neurological complications were found. The postoperative EEG changes were characterized by a slight delta-theta increase, an alpha decrease and a significant slowing of the dominant frequency from 9.7 to 9.3 Hz. In brainstem auditory evoked potentials no changes were found, and in somatosensory evoked potentials (median nerve) the latency of the early cortical component, N20, increased. Cardiovascular reflexes showed increased changes, similar to those found in autonomic neuropathies. In the neuropsychological test battery, the Visual retention test (Benton) and the Rorschach test showed slight postoperative improvement, whereas other psychometric variables (flicker fusion frequency, reaction time) did not change. Despite an improved operative technique some minor clinical and neurophysiological disturbances of the central nervous system remain. However, specific pre- or peri-operative risk factors for these postoperative disturbances or complications could not be identified.

Adult↗

In vitro hematological testing of rotary blood pumps: remarks on standardization and data interpretation.

Pump test procedures using blood will have to meet several standards not only to obtain reliable results in vitro but also to allow comparison of results of different investigators. This article reviews some of the issues that should be considered in pump testing, especially referring to the discussions held at the International Workshops on Rotary Blood Pumps in 1988 and 1991. The test loop itself should meet some requirements such as constant physiological temperature, standardized circulating volume, control of pressure and flow, and exact definition of the blood-contacting surface. Specifications have to be made concerning the test fluid blood, including sampling technique, anticoagulation, blood gases, pH, and glucose level. Only fresh blood should be used. Heparin is recommended for anticoagulation because it will be used also in vivo. Different procedures for cleaning and rinsing of plastic materials for reuse are mentioned. Bacterial overgrowth, which can lead to extreme oxygen consumption and acidosis, may be avoided through addition of antibiotics (e.g., gentamicin). To be able to compare data of the different working groups, a new modified index of hemolysis (MIH) has been defined.

Animals↗

Mechanical blood traumatization by tubing and throttles in in vitro pump tests: experimental results and implications for hemolysis theory.

Blood has become essential as a test fluid to evaluate hemolysis and biocompatibility of blood pumps in vitro. The blood is usually pumped from a blood bag into a circuit against elevated pressure. A throttle or a length of tubing is used to produce the pressure head. Blood damage caused by the shear stress in these pressure-reducing devices should be minimal. It is not known whether the high but short-lasting shear stress in a throttle is more or less damaging to the blood than the low but long-lasting stress in tubing. In this study, throttles (width 11 mm, minimal height 0.9 mm, length 30 mm; shear stress = 136 N/m2 lasting for 3.23 ms); and tubing (inner diameter 9.5 mm, length 4.5 m, shear stress = 4.5 N/m2 lasting for 3.5 s) were compared at a flow of 5 L/min and a pressure drop of 150 mm Hg. Experiments (n = 10) with bovine blood were performed in two parallel setups using Bio-Medicus pumps BP80. Free hemoglobin in plasma (fHb) and thromboxane B2 (TXB2) were measured. After 6 h, the fHb increase was 31.9 +/- 19.1 mg% for the throttle setup and 32.3 +/- 16.2 for the tubing setup. The TXB2 release was 296 +/- 70 and 305 +/- 54 pg/0.1 ml respectively after 4 h. In summary, no significant differences between the two setups for either fHb or TXB2 could be detected. So the use of a throttle, which requires far less priming volume and a smaller blood-contacting surface while also offering a wider range of adjustment, seems preferable.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

In vitro investigation of thrombogenesis in rotary blood pumps.

Thrombus formation at sealing and stagnation areas remains a major problem in the development of rotary blood pumps. Until now, the complex phenomena could only be studied in vivo. In this study, an in vitro mock circulation previously used for hemolysis studies was adapted for thrombosis evaluation. Blood was collected in the slaughterhouse with strict avoidance of air contact and was heparinized (1.5 U heparin/ml blood; activated coagulation time [ACT]: initially, 140-180 s; after collection, 400-600 s). During the test, the ACT decreased gradually. The tests were stopped after 90 to 180 min at an ACT of 1.5 times the initial value. Thrombus formation was observed at the same locations as observed in left-heart assist devices (sealing area, connecting bolts, and stagnant water areas at connectors). The thrombi were similar in shape, color, and histology to those found after 2 to 4 days in vivo. This test provides a valuable tool for evaluating thrombus formation in prototypes and screening tests of different rotary pump designs.

Animals↗

The heart: location of the human soul--site of surgical intervention.

Over millennia, the heart has played an important role in philosophy, medicine, literature, art, and theology. Most cultures consider the heart to be the location of the soul or mind, the "center" of the human body. Modern natural sciences, however, downgrade it to a mere organic blood pump and, simply, a site of surgical interventions. Dealing with this central organ of the body, cardiac surgery is a royal discipline among the medical professions and is highly respected by the public.

Cardiac Surgical Procedures↗

Early bacterial infections in lung transplant recipients.

Early bacterial pulmonary infections within 2 weeks after lung transplantation were studied in 29 patients undergoing surgery between December 1989 and May 1992. Suspected pulmonary infections occurred in 11 patients (38 percent). The most common bacterial organisms isolated were Klebsiella pneumoniae (45 percent; 5/11), Pseudomonas aeruginosa (36 percent; 4/11), Escherichia coli (27 percent; 3/11), Staphylococcus aureus (18 percent; 2/11), and Enterobacter cloacae (18 percent; 2/11). The mortality due to infection was 3 percent (1/29) in the early postoperative period. None of the following variables was found to be of prognostic significance: positive donor cultures, ischemic time of the graft, use of cardiopulmonary bypass, number of courses of methylprednisolone for acute rejection, duration of postoperative intubation, and type of surgical procedure. The presence of infection in the early postoperative period did not influence long-term survival. In the absence of prognostic parameters, prompt adjustment of antibiotic therapy to the results of antibiograms remains the most important therapeutic step in the management of infections in the early postoperative period after lung transplantation.

Adult↗

Doppler sonographic evaluation of the Duromedics-Edwards bileaflet valve at five-year follow up.

In order to define normal flow characteristics at mid-term follow up, prospective Doppler echocardiographic studies were performed in 145 patients (mean age 49.3 years) with Duromedics-Edwards bileaflet valve prostheses (76 aortic, 55 mitral and 14 double aortic and mitral) at a mean interval of 5.2 years following operation. All patients had clinically normal prosthetic valve function and no clinical or radiographic signs of heart failure. None of the patients had severely impaired left ventricular function as assessed by cross sectional 2D echocardiography. Mean peak velocity across prostheses in the aortic position was 2.8 +/- 0.5 m/sec, corresponding to a calculated instantaneous peak pressure gradient of 31.4 +/- 10.2 mmHg. Gradients varied inversely to valve size, although differences were significant only when comparing the 19mm and 21mm versus the 27mm valve (p < 0.05). In the mitral position the mean of peak velocity was 1.8 +/- 0.3 m/sec and pressure half time was 102 +/- 14 msec, representing a calculated mean orifice size of 2.2 +/- 0.5 cm2, with no significant difference between valves of different sizes. Paravalvular regurgitation was more common in the aortic than in mitral position (39% vs. 4%, p < 0.05), although in all cases it was mild (range less than one centimeter from prosthesis ring) and clinically insignificant. We conclude that normally functioning DE valve prostheses have a predictable range of Doppler echocardiographic parameters, although the individual variability of pressure gradients and effective valve area (in mitral valves) has to be emphasized. Nevertheless, the Duromedics Edwards valve shows good hemodynamic properties at mid-term follow up.

Adolescent↗

In vitro and in vivo endothelialization of glutaraldehyde treated bovine pericardium.

In an experimental study, endothelial cell seeding on glutaraldehyde-fixed and detoxified bioprosthetic tissue, suitable for valve fabrication, was investigated in vitro. These findings were compared to spontaneous endothelial cell ingrowth on vascular grafts fabricated from the same materials. Special consideration was given to the quality of cell attachment with regards to improved shear stress resistance in the endothelial layer covering the bioprosthetic surface. On glutaraldehyde detoxified bovine pericardium, in vitro endothelial cell seeding resulted in uninhibited cell proliferation, but the cells were loosely bound to the underlying tissue. In vivo, endothelial cells grew spontaneously over the surface of vascular implants in direct contact with the bioprosthetic material. In contrast to standard fixed bovine pericardium, a significant decrease in thrombotic appositions could be observed. Cells exhibited intensive production of extracellular matrix, which renders the method of spontaneous in vivo cell ingrowth as the most promising approach for further research.

Animals↗