Education and career preparation. Work group proceedings.
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Adolescent↗
Biomedical subjects
J Fischer
Publications and source records attributed to J Fischer.
[Development of recurrences following lumbar intervertebral disk operations].
From a case material of 2845 operations on lumbar disc herniations the recurrences are displayed in tabular form and also numerically. On the basis of an operation "model" an attempt is made to assess the radicality of the clearing out of the intervertebral space. In addition the essential developmental history and the anatomical aspects are summarised and the present state of knowledge concerning the processes of aging and degeneration in the disc space commented on.
Adult↗
Intensified induction and consolidation with or without maintenance chemotherapy for acute myeloid leukemia (AML): two multicenter studies of the German AML Cooperative Group.
In two multicenter trials, a total of 576 patients with acute myeloid leukemia (AML) were treated and found to be evaluable. Two hundred forty-two patients were in a 1978 pilot study and 334 patients were in a 1982 randomized study. Ages were between 15 and 78 years (median, 48). The uniform remission induction therapy in both studies consisted of one to two courses of a 9-day combination of 6-thioguanine (TG) with cytosine arabinoside (ARA-C) and daunorubicin (DNR) [TAD9]. The timing and sequencing of TAD9 was designed according to cell kinetic effects of ARA-C. A complete remission (CR) was achieved in 65% (70% and 61%, respectively) of patients within a median of 33 days, and in 68% of responders after only one course. The CR rate in patients 60 to 78 years of age was 51% (66% and 39%, respectively). In the 1978 pilot study, different protocols of post-remission treatment were applied at the different centers: monthly 5-day maintenance, TAD9 consolidation, both consolidation and maintenance, or no further therapy. The group receiving treatment during CR showed 24% probability of remissions at 4 years v 0% probability of remissions in the untreated group. Between the different post-remission protocols, no significant differences were observed. Remission duration was not influenced by age, WBC, or morphologic cell type, but was longer in patients achieving CR within 30 days (P = .017). In the subsequent 1982 study, 145 patients in CR were randomized for TAD9 consolidation with or without monthly maintenance. The updated life-table analysis revealed a predicted rate of continuous remission at 2 1/2 years of 30% for the maintenance and 17% for the nonmaintenance arm (P = .003). These results of response and remission duration in adult patients of all ages support the validity of intensified induction therapy and of consequent myelosuppressive treatment in remission.
Actuarial Analysis↗
[Esophagus perforation--treatment and results].
Esophageal perforation is most often caused by instrumental lesion during endoscopy. Mortality is still high; underlying malignant disease, septic complications and cardiopulmonary problems are endangering the patient. In small perforation with poor clinical symptoms, conservative treatment (i.e. antibiotics, gastric suction, parenteral nutrition) should be considered. We could treat in this way more than 50% of our cases. On the other hand, some patients require agressive surgical procedures, e.g. cervical esophagostomy gastrostomy and disconnection of esophageal continuity.
Adolescent↗
[Partial vertical nucleotomy. A neurosurgical intervention in some forms of therapy-resistant facial neuralgia].
The partial vertical nucleotomy is presented as a new neurosurgical method for the treatment of therapy-resistant pain in the spreading area of the N. trigeminus. Strict indications are laid down which are mainly restricted to therapy-resistant pain in the above mentioned spreading area in the presence of diffusely growing malignant tumours, after traumas and infections and predominantly in forms of idiopathic trigeminal neuralgia that has been treated without any results over a period of many years. In the experimental part of the article; material and method as well as results of anterograde transport on the efferent trigeminal pathways in rabbits by means of horseradish peroxi- dase (HRP) and its representation by means of tratramethylbenzidine (TMB) are discussed. Furthermore fibre preparations of the tractus and nucles spinalis nervi trigemini and the radiating fibres of the Nervus vagus are shown.
Aged↗
The clinical significance of alpha 1-antitrypsin-elastase (alpha 1AT-ELP) and alpha 2-antiplasmin-plasmin (alpha 2AP-PL) complexes for the differentiation of coagulation protein turnover: indications for plasma protein substitution in patients with septicaemia.
In inflammation, particularly in septicaemia, complex coagulation disorders may lead to a dangerous haemorrhagic diathesis. The conventional concept for this syndrome called DIC implicates the occurrence of active thrombin in the circulation, which may be followed by hyperfibrinolysis due to plasmin formation. In this study data are presented suggesting an important role for a third proteolytic system, granulocytic elastase. The complexes of plasmin and elastase with their specific inhibitors, alpha 2-antiplasmin-plasmin (alpha 2AP-PI) and alpha 1-antitrypsin-elastase (alpha 1AT-ELP) were determined immunologically. The alpha 1AT-ELP appears mainly in gram-negative septicaemia, particularly in meningococcal disease. The estimation of alpha 2AP-PI and alpha 1AT-ELP, together with a method for the detection of the antithrombin III--thrombin complex which remains to be established, is a suitable tool for for the differential diagnosis of the consumption of coagulation proteins. The assumption that at least three proteolytic systems participate in the development of the haemorrhagic diathesis during inflammation leads to the concept of a broad, comprehensive substitution therapy with e.g. concentrates of AT III, PPSB, or fresh frozen plasma. The aim of this treatment is to replace not only the consumed procoagulatory factors, but also the lacking inhibitors in order to control this "abnormal proteolysis syndrome".
Adult↗
Detection and characterization of monoclonal antibodies specific to IgE receptors on human lymphocytes by flow cytometry.
BALB/c mice were immunized with human lymphoblastoid cells (RPMI 8866 cells) expressing surface receptors for IgE (Fc epsilon R). Spleen cells from animals displaying high titres of anti-Fc epsilon R antibodies were fused with HGPRT-deficient NSI myeloma cells. Anti-Fc epsilon R antibodies were identified by a flow cytometric assay based on their ability to block the binding of IgE-coated fluorescent latex particles to Fc epsilon R-positive cells. Fourteen monoclonal hybridoma cell lines secreting antibody of the required specificity were amplified in tissue culture and then grown in the peritoneal cavity of BALB/c mice in order to obtain ascitic fluids with high antibody titres. The specificity of each monoclonal antibody (Mab) to lymphocyte Fc epsilon R was shown by the following observations: (i) the intact monoclonal antibody molecule or, in some cases, its F(ab')2 fragments blocked the binding of IgE to several Fc epsilon R(+) cell lines different from that employed for the initial immunization; (ii) the Mab bound directly to all the Fc epsilon R(+) cell lines tested, but not to several Fc epsilon R(-) cells as determined by indirect immunofluorescence; (iii) the binding of Mab to Fc epsilon R(+) cells was selectively blocked by IgE, but not by the other classes of Ig; and (iv) Mab had no effect on the binding of IgG to Fc gamma R on normal human peripheral blood mononuclear cells (PBMC).
Animals↗
[Significance and new possibilities of the morphologic study of carbohydrates].
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Animals↗
[Effectiveness of combined plasma exchange treatment in fulminant viral hepatitis].
The plasma exchange is an effective measure in the treatment of acute liver failure. The authors report their own first experiences in this field in the management of fulminant viral hepatitis. Four out of 7 treated patients survived. So, the survival rate was augmented from 25 per cent in a control group of 8 patients without plasma exchange to 57.1 per cent. Other necessary therapeutic measures are high energetic nutrition, branched chained amino acids, stimulation of liver cell regeneration, correction of coagulation alterations, and intensive care. The success depends on coma stage in the beginning of treatment. Patients with signs of praecoma should be admitted to specialized centers. The number of such centers should be limited because of the necessary experiences and the high costs of combined plasma exchange treatment of this rare hepatitis complication.
Adolescent↗
Isolation and chemical and immunochemical characterization of the peanut-lectin-binding glycoprotein from human milk-fat-globule membranes.
Membrane glycoprotein with high Mr (HMr-MGP) was purified from neuraminidase-treated Triton X-100-solubilized human milk-fat-globule membranes by peanut-agglutinin (PNA) affinity chromatography. The high carbohydrate content (75%), blood-group-A activity and typical monosaccharide composition (L-fucose, D-galactose, N-acetyl-D-glucosamine and N-acetyl-D-galactosamine in the proportions 0.26:1.00:1.85:1.30) indicate that the isolated HMr-MGP is a mucinous substance. Fractionation of the oligosaccharides from alkaline-borohydride-treated HMr-MGP on Bio-Gel P-2 suggest that the PNA-binding sites are located mainly on longer (tetra- to deca-saccharide) alkali-labile bound oligosaccharide chains. Polyclonal antibodies raised against the HMr-MGP showed an antigenic distribution in histological sections that was comparable with the distribution of peroxidase-labelled-PNA-binding sites in both normal and malignant breast tissues. The positive immunohistological staining of some other tissue components with this antibody indicates that HMr-MGP is not strictly breast-associated. The functional role of HMr-MGP is unknown, but, since its expression is dependent on the differentiation state of secretory epithelial cells, it serves as a differentiation antigen that can be used for better functional characterization of breast cancers.
Adenocarcinoma↗
[Immunoprevention of hepatitis B in children of HBsAg-positive pregnant patients].
Children of hepatitis-B-surface-antigen-positive women are, depending upon the degree of maternal infectivity, exposed to a very different risk of hepatitis B. In the GDR the rate of infectious pregnant women is low. The serious consequences of a perinatal hepatitis B, which very often leads to a chronic course and virus carriers, may widely by prevented by immunoprophylaxis. Various methods for the establishment of a risk are described. The hepatitis-B-surface-antigen screening in 28 127 pregnant woman showed 20 = 0,07% of carriers of findings, 4 out of them HBeAg-positive. From the performance of the passive immunisation in 6 babies of HbeAg-positive mothers and 2 newborn without maternal HBe- or anti-HBe-proof and from the results of the control of 17 children, who were not immunized, when there was an anti-HBe-positiveness or when there was no proof of HBe-markers, result recommendations for practice.
Carrier State↗
[Clinico-epidemiological aspects of acute cerebrovascular diseases].
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Age Factors↗
Long-term remission in acute myelogenous leukaemia.
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Adolescent↗
Competing risk factors associated with nosocomial infection in two university hospitals.
An historical cohort study of risk factors associated with nosocomial infection was conducted in two university hospitals on the East and West Coast of the USA. The purpose of the study was to estimate the relative risk ratios (RR) associated with antibiotic therapy, instrumentation, surgical operations and age with nosocomial infection, and to establish the hierarchical relationship of these factors to each other. A high risk cohort of long-staying patients (average length of stay = 30 days), was selected and each patient's chart was analysed retrospectively for infection occurrence and for risk factors. There was no significant difference between hospitals in rates of nosocomial infections, diagnostic categories and utilization of risk factors. Categorical linear regression analysis showed that a four factor model consisting of antibiotic therapy, instrumentation, surgical operations and age accounted for 95 per cent of the variation in nosocomial infection rates. Length of stay was treated as a co-dependent variable. Multivariable stratification analysis yielded aetiologic fractions of 63 per cent attributable to antibiotic therapy, 26 per cent to surgical operations, and 13 per cent to instrumentation. About half the antibiotic therapy was given on admission or at least 4 days before the first hospital-acquired infection. These data support careful assessment of prophylactic antibiotic therapy and infection control policies to reduce risk of nosocomial infection in university hospitals.
Anti-Bacterial Agents↗
Limitation of exercise-induced R wave amplitude changes in detecting coronary artery disease in asymptomatic men.
The exercise electrocardiograms of 255 asymptomatic men were analyzed for changes in R wave amplitude and ST segments. The results were correlated with findings at cardiac catheterization. There were 65 men with coronary artery disease and 190 normal subjects. R wave amplitude changes were evaluated in bipolar leads X, Y and Z. The predictive value of an abnormal ST segment response for detecting disease was only 29%. This value was improved to 42% using R wave amplitude changes with a sensitivity of 28% and specificity of 87%. Exercise-induced R wave amplitude changes enhance the specificity of detecting coronary disease in asymptomatic men over ST segment criteria alone but the sensitivity is poor and the predictive value is not enhanced. Thus, these criteria are limited in adding to the diagnostic accuracy of stress testing.
Adult↗
Discriminant value of clinical and exercise variables in detecting significant coronary artery disease in asymptomatic men.
To determine whether clinical or exercise test variables could reliably detect coronary disease in asymptomatic men, several variables were compared with angiographic findings in 225 asymptomatic men. None of the individual clinical or rest electrocardiographic variables were able to detect coronary artery disease. The three individual exercise variables with a high likelihood ratio were: 1) at least 0.3 mV ST depression, 2) persistence of ST depression 6 minutes after exercise, and 3) total duration of exercise of less than 10 minutes. However, because of low sensitivity and predictive value, these single variables were not helpful in identifying individual patients with coronary disease. The combination of any single clinical risk factor and any two of these exercise risk predictors was highly predictive (89%) but relatively insensitive (37%) for detecting any coronary disease. These criteria have a sensitivity of 55% and a predictive value of 84% for the detection of two and three vessel coronary disease. The effectiveness of exercise testing for detecting asymptomatic coronary disease is improved when the group is first screened for the presence of risk factors and additional exercise variables other than ST segment criteria are evaluated.
Adult↗
Characterization of glycoconjugates of human gastrointestinal mucosa by lectins. I. Histochemical distribution of lectin binding sites in normal alimentary tract as well as in benign and malignant gastric neoplasms.
Labeled lectins with binding specificity to the hexose components of mucus glycoproteins (HPA, RCA I, PNA, Con A, WGA, and UEA I) were used to demonstrate structural differences in the glycoprotein composition of various cell types of the normal, benign and malignant gastrointestinal mucosa. While in the RCA I, UEA I, and WGA binding of normal mucus secreting cell types only quantitative differences were observed, the mucus in the surface epithelial cells of gastric mucosa and in the colonic goblet cells was characterized by the absence of PNA, Con A, and PNA, HPA binding sites, respectively. These lectins, however, showed a strong binding to the supranuclear, Golgi-region in the undifferentiated or activated forms of these cells. Even the staining intensity of the luminal membrane surfaces of the non mucinous parietal and chief cells was often stronger by PNA, HPA, and RCA I lectins than that of the mucus secretions in the highly differentiated mucus cells. These results indicate the existence of either heterogeneous glycoprotein components or mucus molecules with variations in the degree of glycosylation of their oligosaccharide chains in the different cells. The latter seems more likely since in benign and malignant alterations lectin binding sites appear in great density, which were found to be characteristic of the undifferentiated mucus cells or for the non mucinous cells of the normal gastric mucosa. Similarly in some gastric cancers which do not stain with the periodic acid-Schiff reaction at all, large amount of free or neuraminic acid substituted PNA binding sites can be detected.
Adenocarcinoma↗
Characterization of glycoconjugates of human gastrointestinal mucosa by lectins. II. Lectin binding to the isolated glycoproteins of normal and malignant gastric mucosa.
Using affinity chromatography on HPA-, PNA-, Con A, and WGA-agarose columns only a part (10-30%) of the high molecular weight mucous glycoproteins could be isolated from the Triton X-100 solubilized components of normal as well as carcinomatous gastric mucosa. The main part of the mucus was not bound by the lectins, which corresponds to our earlier lectin histochemical observations on paraffin-embedded tissue sections. The lectin-bound mucous glycoproteins had a relatively lower molecular weight, ranging from about 250-1,000 kilodaltons, as indicated by polyacrylamide gradient gel electrophoresis and by gel filtration on Biogel A 1.5 m column. In gas chromatographic analysis the molar ratio of aminohexoses to galactose was found to be much higher (3:1) in the lectin-bound mucous substances than in the whole high molecular weight mucus (1:1). This finding indicates that lectins have a higher affinity to the hexosamine rich components of mucus, which may be special forms of mucous glycoprotein molecules or the incompletely glycosylated core and backbone regions of the oligosaccharide chains of mucus. Extremely high hexosamine values (10:1) were found in the PNA isolated mucus of gastric adenocarcinoma. Since it is known that PNA binds to the terminal disaccharide, beta-galactose-(1-3)-N-acetylgalactosamine, which is localized at the reducing end of the oligosaccharide chains of mucus, it is highly probable that the elongation of the oligosaccharide side chains is disturbed in gastric cancer cells.
Binding Sites↗