Pulmonary embolism and hydrogen peroxide.
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Embolism, Air↗
Biomedical subjects
H Gerber
Publications and source records attributed to H Gerber.
Chicken antibodies to a recombinant fragment of the equine immunoglobulin epsilon heavy-chain recognising native horse IgE.
An equine immunoglobulin E (IgE) heavy-chain cDNA fragment (CH3-CH4, nucleotides 1132 to 1592) was cloned, expressed in Escherichia coli as a fusion protein with a [His]6-tag and purified over a Ni-NTA column. The recombinant protein was used to immunise hens. Testing of the raised egg yolk immunoglobulin G (IgG) in Western-blot and ELISA revealed high titres against the recombinant equine IgE fragment (reqIgEf). The reqIgEf-specific IgG was successfully affinity-purified on an unconventional affinity matrix: the [His]6-tagged recombinant IgE fragment was bound to Ni-NTA agarose and used to adsorb specific immunoglobulins. In Western-blot of ammonium sulphate precipitated horse serum and bronchoalveolar lavage fluid, separated by SDS-PAGE under denaturing-reducing conditions, the raised antibodies reacted with a protein of approximately 80 kDa. A reaction of the reqIgEf-specific IgG was seen with a 190-200 kDa band when the same horse serum or bronchoalveolar fluid (BALF) was separated under non-reducing conditions. These reactions could be inhibited by preincubation of the immune IgG with reqIgEf, while preincubation with horse IgG did not inhibit the reaction. Antibody-affinity chromatography of horse serum with the reqIgEf-specific chicken IgG resulted in an enrichment of the 80 kDa protein in denaturing Western-blot. Determination of the amino acid composition of this protein and comparison with the equine IgE heavy- chain sequence strongly indicates that the 80 kDa band corresponds to the heavy chain of the horse IgE. The reqIgEf-specific chicken IgG was further characterised in an ELISA for the detection of allergen-specific horse IgE. It was demonstrated that heating IgE positive horse sera at 54 degrees C for 10 min drastically diminished the recognition by the reqIgEf-specific chicken IgG. The reaction is inhibitable by preincubation with reqIgEf in a concentration dependent manner. In addition, preincubation with horse IgG, a nonrelevant [His]6-tagged protein or 2% equine colostrum had no influence on the reqIgEf-specific chicken IgG binding characteristic. This antibody recognising horse IgE will be useful for further studies on the pathogenesis of equine allergic diseases.
Amino Acids↗
Is an alkalinized lignocaine solution a better topical anaesthetic for intratracheal application?
Topical anaesthesia of the trachea is used to avoid coughing during emergence from anaesthesia. This study was designed to compare the effects of an alkalinized lignocaine and plain lignocaine solution given intratracheally. After institutional approval and written informed consent, 30 patients were randomized into three groups and received in a double-blind fashion: lignocaine, alkalinized lignocaine and normal saline for control. After application of normal or alkalinized lignocaine the tolerance to the tube was significantly better during extubation (P = 0.001). Noradrenaline levels were significantly diminished in the lignocaine groups (P < 0.05). Plain and alkalinized lignocaine solutions for topical anaesthesia significantly improved tolerance to the tracheal tube during emergence from anaesthesia. Plain and alkalinized lignocaine given directly before intubation reduced the sympathomimetic stress response resulting in a lower noradrenaline concentration and a reduced heart rate.
Adolescent↗
Expression patterns of extracellular matrix components in native and cultured normal human thyroid tissue and in human toxic adenoma tissue.
The extracellular matrix (ECM) and basement membranes (BM, a specialized form of ECM) greatly influence proliferation, differentiation, and function of cells and the structure of tissues. While a considerable amount of information is available on thyroid cellular proliferation, differentiation and function, much less is known about thyroid ECM and BM. In this study the presence of the ECM/BM components fibronectin, collagen IV, alpha1, beta1, gamma1 laminin, several laminin variants, osteonectin, and perlecan was demonstrated in cryosections of nonadenomatous and toxic adenoma human thyroid tissue. Also, positive immunohistochemical staining for collagen IV, laminin, perlecan, and fibronectin was obtained in sections of human thyroid tissue cultured in a three-dimensional (alginate) culture system. The present study provides methods and data that will facilitate the investigation of the interaction between cells and ECM in thyroid tissue.
Adenoma↗
Latex allergy to the tape of the cardio-tocograph.
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Adhesives↗
The prevalence of latex sensitivity among anesthesiology staff.
Reports dealing with allergic reactions to latex among health care professionals are increasing steadily. This study is the first epidemiological investigation of latex allergy among anesthesia staff. We tested 101 persons of the staff of the Institute of Anesthesiology, Kantonsspital, Lucerne, Switzerland, using a standardized questionnaire, prick test (latex extract), scratch test (latex glove), and immunoglobin E (IgE) analysis. Sixteen of 101 persons (15.8%) had a positive skin test. Two of them had a positive radioallergosorbent test (RAST) Class II, and one person was Class I. Risk factors were a history of atopy (P < 0.001) and positive skin tests on atopy screening (P = 0.016). IgE levels were increased in the latex-sensitive group. Three of the 11 sensitized persons (total sensitized persons 16) who performed spirometry had significantly reduced expiratory peak flow values during working hours. It is concluded that anesthesiology staff is at high risk of allergic sensitization to latex. The most important risk indicator was an atopy. Skin tests are more sensitive than blood tests (i.e., specific antibodies, IgE).
Adult↗
[The therapy of equine sarcoid with a non-specific immunostimulator--the epidemiology and spontaneous regression of sarcoids].
20 sarcoid-affected horses from a practice in the northern Jura were used in this experiment. The mean age of the 20 horses was 3.9 years at the time of the first observation of sarcoid tumors. On the average, 4.4 tumours were noted per horse. 10 of the horses were treated in a double-blind study with an unspecific immunostimulant (Baypamun P), 10 others received a placebo. One single tumour only was treated per horse. The injections were given under and around the sarcoid. In eight out of the 20 horses all tumours regressed totally or for more than 50% of their initial size. Five of these had received placebo, three the immunostimulant. Four animals showed a modest, but measurable reduction in tumour size (3 immuno-stimulant, 1 placebo) and in the remaining eight horses (4:4) no reduction or even an increase in tumour size was observed. The phenomenon of tumour regression was very probably due to spontaneous regression and horses which had been observed to develop sarcoid within the last three months had significantly more regressions than animals with older tumours (p < 0.05). The haplotype of the equine leucocyte antigens was thought to predispose 12 of the 20 horses for the sarcoid. However, the ELA-type did not measurably influence the phenomenon of tumour regression.
Adjuvants, Immunologic↗
Ultrasound spirometry in the horse: a preliminary report on the method and the effects of xylazine and lobeline hydrochloride medication.
A new computerised ultrasound-based spirometry system according to Buess et al. (1995) modified by a double flow measurement facility was used to study pulmonary function in healthy horses and horses affected with subclinical and manifest chronic bronchiolitis (CB). The horses were first evaluated at rest without any medication. On another occasion all horses were tested following i.v. administration of xylazine (0.4 mg/kg) and following i.v. administration of lobeline hydrochloride (l.hy.; 0.2 mg/kg) to evaluate the effect of xylazine and l.hy. on different spirometric variables. Ultrasound-based spirometry proved to be an easily applicable method for lung function testing, even in difficult horses. However, there existed a pronounced physiological variation for all measured lung function parameters and no significant differences between healthy horses and horses with chronic bronchiolitis could be found except for the expiratory tidal volume (VTE p < 0.05). Individually, a marked decrease of variability from breath to breath following either xylazine and l.hy. administration could be observed for all parameters, except the flow-time-ratio (Tpef./ Texp.) and the flow-volume-ratio (Vpef./Vexp).
Animals↗
[Value of monitoring muscle relaxation].
INDICATION: Sensitivity to neuromuscular blocking agents differs between individuals, and residual neuromuscular blockade is a common postoperative problem. Clinical signs such as head lift, hand grip, and inspiratory force are suitable means of showing residual blockade. However, an awake and cooperative patient is needed. Therefore, in clinical practice it is advantageous to use the responses evoked by a nerve stimulator. SITES OF NERVE STIMULATION AND DIFFERING MUSCLE RESPONSE: In clinical anesthesia, the ulnar nerve is the most popular site. The response is evaluated by feeling the contractions of the adductor pollicis muscle. This muscle shows a slow onset of blockade and is highly sensitive to neuromuscular blocking agents. Therefore, the chance of overdosing the patient is decreased and during recovery additional safety is gained, as it can be safely assumed that at the time of normalization of the thumb twitches no residual blockade exists in the diaphragm or larynx. On the other hand, absent twitches of the adductor pollicis using train-of-four stimulation do not preclude intraoperative activity of more resistant muscles such as the diaphragm. RECORDING OF EVOKED RESPONSES AND PATTERNS OF NERVE STIMULATION: In clinical anesthesia, tactile evaluation of the muscle response is the usual method. Mechanomyography (Myograph) with a force transducer is used as the reference standard. This method, as well as the measurement of acceleration (Accelograph, TOF-Guard) and electromyography (Relaxograph) are mainly tools for teaching and research. Different patterns of nerve stimulation are used: during induction, single-twitch stimulation at 1Hz; during profound blockade, post-tetanic count stimulation (PTC); surgical blockade is evaluated using train-of-four stimulation (TOF); and recovery is followed by double-burst stimulation (DBS). Using simple train-of-four stimulation during recovery, a device is needed with a registering capacity to accurately determine a TOF-ratio > 0.7. CONCLUSIONS: Relaxometry allows monitoring of neuromuscular function independently of the patient's cooperation, and should be standard. In the intensive care unit, relaxometry helps to minimize the risk of overdosing. However, muscular weakness can persist despite adequate drug dosage. Relaxometry is only part one of a concept. Intubating and operating conditions are highly dependent on the depth of anesthesia, and the risk of postoperative residual blockade can be minimized by using short or medium action drugs.
Electric Stimulation↗
[Electronic expert system in medicine. For example ILIAD].
Expert systems are knowledge data bases founded on patient data, literature searches and opinions of experts. With these systems it is for instance possible to test or to take clinical decisions. ILIAD, USA version 4.2, an adaptable software using probabilistic strategies, was investigated. This system is, among other uses, employed for quality assurance and documentation, as a teaching instrument as well as a knowledge base. It comprises the ICD-9 index of diagnoses and a selected and commented up-to-date review of the literature from 'Mosby's Year Book of Medicine'. The features of ILIAD are presented, and the possibilities and limitations of its use as well as that of expert systems in general are discussed.
Diagnosis, Computer-Assisted↗
[Latex allergy--not only a threatening danger to patients. A case report from an anesthesiological department].
A 31-old male nurse of anesthesiology was exposed to rubber gloves over a period of ten years. An atopic diathesis was known. From time to time he had episodes of pollinosis. Since nine months he had suffered from conjunctivitis, rhinitis and shortness of breath while wearing latex gloves. During a night shift ten minutes after consumption of tropical fruit (bananas, kiwi) he had to care for a patient in the emergency room. He wore rubber gloves and had to clean the emergency room. Initially, his palms and feet itched. Then he experienced angor and increased perspiration 90 seconds later he suffered severe dyspnea and dysesthesia in the lower extremities. Treatment with theophylline and beta sympathomimetics, steroids and antihistaminics was successful. This male nurse had a positive history for contact urticaria after exposition to rubber. He suffered a dramatic exacerbation when wearing latex gloves and inhaling latex-contaminated air after eating tropical fruits. Fruit could have been a potent booster. Hospital employees with a history of atopic disease should be screened for potential latex allergy before occupational exposure.
Adult↗
[Tumor embolism with fatal cerebral infarct in pneumonectomy. Case report and review of the literature].
Carcinomas of the bronchi often infiltrate veins, particularly in advanced stages. Tumor propagation in pulmonary veins with intra-atrial extension has been reported. Systemic arterial tumor embolism is a potentially fatal hazard that is caused by surgery or it can be the initial manifestation of a bronchogenic carcinoma. The importance of early pulmonary venous ligation in lung cancer surgery, first stressed by Aylwin in 1951, is evident, particularly when intravenous tumor progression has been diagnosed preoperatively by echocardiography or CT scan. We report a case of lethal hemispheric brain infarction following tumor embolism during lobectomy for bronchus carcinoma. A review of the literature on this subject is presented; there were 38 cases of arterial tumor embolism because of primary lung neoplasms.
Aged↗
Model of the athymic nude mouse for the study of benign goiter disease.
Since Shimosato et al., in the mid 70s transplanted for the first time thyroid carcinoma tissue onto nude mice, other research groups have made use of the nude mouse model for the investigation of xenotransplanted thyroid tissue. The use of this model for the investigation of benign goiters is briefly discussed in this article. Normal human thyroid tissue has been transplanted either as a control in experiments with benign and malignant goiter tissue, or for the study of thyroid tissue response to stimulators such as TSH or thyroid stimulating antibodies (TSAb). Thyroid glands from 8- to 10-week old human fetuses obtained at the time of legal abortion were cryopreserved in liquid nitrogen and successfully transplanted into nude mice. Moreover, all the variants of human benign goiter tissue have been xenotransplanted: tissue from nodular and diffuse goiters, hot and cold nodules or goiter areas, rapidly growing nodules, etc. Two examples of animal thyroid tissue xenotransplantation onto nude mice are briefly discussed: Nude mice bearing normal thyroid tissue transplants from 4 different species (man, rat, pig, guinea-pig) have been used for the study of the species specific effect of bovine TSH and TSAb. In studies aiming at elucidating the pathogenesis of hyperthyroidism, toxic goiter tissue from hyperthyroid cats has been transplanted. In methodological terms, these experiments have shown that surgically removed goiter tissue can be shipped by air in cell culture medium at 4 degrees C over long distances and then successfully transplanted.-Finally, cell lines such as the rat cell line FRTL-5 can be transplanted onto nude mice either as cell suspension or embedded in collagen, for example for the study of proliferation and folliculogenesis. Using the xenotransplantation model, function and proliferation, morphogenesis and differentiation, as well as thyroid autonomy and response to stimulators have all been studied in xenotransplanted human and animal thyroid thyroid tissue and cell lines under various experimental conditions. Although new research tools, for example transgenic animals, are now increasingly and successfully used, xenotransplantation still offers the possibility of addressing some specific questions which cannot be answered so easily with other experimental models. For example, studies with human tissue, involving drugs or radioactive tracers which cannot be applied to the intact human being, can relatively easily be performed with xenotransplanted human tissue and application of the drug or tracer to the host mouse. Or embryological development can be followed and studied using fetal thyroid (and other) tissue transplanted onto nude mice; here, of course, difficult ethical issues have to be considered. Finally, it should be mentioned that, although many scientific questions can be studied nowadays by cell culture or other in vitro systems, animal models are still needed. Extrapolation to the human being, however, should always be done with caution and we should always keep in mind that for the understanding of a human disease indeed human experimental models remain the goldstandard.
Animals↗
[Clinical aspects, diagnosis and drug therapy of hyperthyroidism].
Graves' disease and toxic uni- or multinodular goiter are the most frequent causes of hyperthyroidism. Graves' disease is caused by thyroid stimulating immunoglobulins which are directed against the TSH receptor of thyroid follicular cells. Graves' disease affects more females than males and is associated with diffuse goiter and a rapid appearance of symptoms and signs of hyperthyroidism. Patients with Graves' disease are on average younger than patients with toxic nodular goiter. The diagnosis of Graves' disease is usually easy, particularly if signs of endocrine opthalmopathy are present. Toxic nodular goiter is seen more often in older patients with pre-existing goiters. Symptoms and signs of hyperthyroidism often appear only slowly. Hyperthyroidism in these older patients can be oligosymptomatic. Older patients should therefore be investigated for the presence of hyperthyroidism, even if they present only a few symptoms or signs which could suggest this diagnosis. The development of ultrasensitive TSH assays has simplified the diagnosis of hyperthyroidism and made the TRH-test, often used in the past, almost superfluous. At the present time, it is practically always possible to differentiate between Graves' disease and toxic nodular goiter as the cause of hyperthyroidism on the basis of clinical and laboratory findings alone, and in many cases thyroid scintiscans are therefore no longer necessary. A patient with newly diagnosed Graves' disease is treated with antithyroid drugs (carbimazole or PTU) for one year. If hyperthyroidism persists after this one year of antithyroid drug treatment, or if it recurs, another year of therapy with carbimazole or PTU is indicated.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[A high serum creatine kinase picture due to too much or too little exercise].
In case I, a 31-year-old man who had undergone unusual high-performance training, painful swellings occurred in the left arm and creatine kinase activity was raised (28,644 U/l), as well as that of the transaminases. A rapid urine test for blood was positive, but the sediment was free of red blood cells. There were no other pathological findings. Fluid intake was increased to 31 daily and on the third day he was symptom-free and creatine kinase activity had fallen to 6475 U/l, reaching normal values on the 15th day. Case 2 concerned a 28-year-old woman with paranoid schizophrenia who had taken several tablets of clozapine and then remained in bed for 3 days. She complained of pain in the region of the gluteus maximus muscles, exacerbated on pressure but otherwise unremarkable. Creatine kinase was raised to 21,492 U/l, creatine to 186 mumol/l, and the transaminases were likewise increased. The urine strip-test for blood was twice positive. She was treated with frusemide (80 mg daily) and infusions of electrolyte solution (21 daily). She became pain-free on the second day and the various enzyme activities rapidly fell to normal.
Adult↗
Brief report: congenital hyperthyroidism caused by a mutation in the thyrotropin-receptor gene.
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Amino Acid Sequence↗
Long-term follow up to patients with frozen shoulder after mobilization under anesthesia, with special reference to the rotator cuff.
UNLABELLED: In order to evaluate the efficacy of mobilization under anesthesia as a therapy for frozen shoulder, 43 patients with a mean age of 52.8 years were examined after an average time of 4.7 years. Since some authors have been concerned about rotator cuff tears, special attention--using sonography--was paid to rotator cuff lesions. RESULTS: Clinical and sonographic examinations were very similar and showed a perfect recovery in 27 of 37 patients (73.0%). The average time off work after mobilization was 6.2 weeks compared with expected spontaneous recovery of about 30 months. Outcome was worse in patients with previous trauma to their shoulder. In 2 patients (5.4%) the sonography revealed a slight rotator cuff tear, which is not uncommon in 60-year-old persons. Two additional patients (5.4%) underwent shoulder surgery two years after mobilization due to a persistent impingement syndrome and to a supraspinatus-tear. We conclude, that mobilization under anesthesia for frozen shoulder is an effective treatment modality causing little harm.
Adult↗