Hospital care for dying patients.
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Biomedical subjects
Publications and source records attributed to J Herrmann.
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A monomeric rat beta-galactoside-binding lectin previously purified from extracts of rat lung has been localized to erythrocytes, and the cDNA encoding it has been isolated from a rat reticulocyte cDNA library. The deduced amino acid sequence of the cDNA predicts a protein with a M(r) of 16,199, with no evidence of a signal peptide. The deduced sequence is identical to the sequences of seven proteolytic peptides derived from the purified lectin. Peptide analysis by mass spectrometry indicates that the N-terminal methionine is cleaved and that serine 2 is acetylated. The lectin shares all the strictly conserved amino acid residues of other members of the mammalian galectin family and is designated galectin-5 (GenBank accession number L36862). Galectin-5 is a weak agglutinin of rat erythrocytes, despite its monomeric structure. The gene encoding galectin-5 (LGALS5) has been mapped in mouse to chromosome 11, approximately 50 centimorgans from the centromere and 1.8 +/- 1.8 centimorgans from the polymorphic marker D11Mit34n, a region syntenic with human chromosome 17q11.
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PURPOSE: The ultimate goal of the Third Intergroup Rhabdomyosarcoma Study (IRS-III, 1984 to 1991) was to improve treatment outcome in children with rhabdomyosarcoma through clinical trials comparing risk-based protocols of surgery and multiagent chemotherapy, with or without irradiation. PATIENTS AND METHODS: One thousand sixty-two previously untreated, eligible patients who were entered onto the study after surgery were randomized or assigned to treatment by clinical group (I through IV), histology (unfavorable or favorable), and site of the primary tumor. Initial responses, progression-free survival (PFS), and survival (S) were the end points used in comparisons between randomized groups and between patients treated in IRS-III and IRS-II (1978 to 1984). RESULTS: The overall outcome of therapy in IRS-III was significantly better than in IRS-II (5-year PFS, 65% +/- 2% v 55% +/- 2%; P < .001 by stratified testing). Patients with group I favorable-histology tumors fared as well on a 1-year regimen of vincristine and dactinomycin (VA), as did a comparable group treated with VA plus cyclophosphamide (C) (5-year PFS, 83% +/- 3% v 76% +/- 4%; P = .18). Results for patients with group II favorable-histology tumors, excluding orbit, head, and paratesticular sites, were inconclusive regarding the benefit from addition of doxorubicin (ADR) to VA. Patients with group III tumors, excluding those in special pelvic, orbit, and other selected nonparameningeal head sites, fared much better on the more intensive regimens of IRS-III than on pulsed VAC or VAC-VADRC in IRS-II (5-year PFS estimates, 62% +/- 3% v 52% +/- 3%; P < .01); however, there were no significant differences in outcome among the groups treated in IRS-III. Patients with metastatic disease at diagnosis (clinical group IV) did not benefit significantly from the more complex therapies evaluated in IRS-III. CONCLUSION: Intensification of therapy for most patients in IRS-III, using a risk-based study design, significantly improved treatment outcome overall. The largest gain from this strategy was realized in patients with gross residual tumor after biopsy (clinical group III). It was also possible to decrease therapy for selected patient subsets without compromising survival.
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After coronary angiography a 66-year-old man developed manifest hyperthyroidism (fT3 8.7 pg/ml, fT4 3.7 ng/dl) marked by tremor, restlessness and sweating. The hyperthyroidism was controlled by high dosages of thiamazole (240 mg daily) and lithium (24-36 mmol daily). But the white cell count dropped from 8,000/microliters to 4,900/microliters on the eighth day. Although the thiamazole dose was reduced to 40 mg daily, the granulocytopenia became more severe and, on the 24th day of treatment, agranulocytosis occurred (neutrophilic granulocyte count 200/microliters), although the thiamazole had been discontinued. The patient was then isolated and treated prophylactically with ofloxacin. Simultaneously he received 5 micrograms/kg granulocyte-colony stimulating factor (G-CSF) subcutaneously daily for 7 days. On the sixth day of this treatment the granulocyte count was 520/microliters, next day 3,800/microliters, and after a further 2 days it overshot to 31,000/microliters, then gradually returning to normal values. -It is recommended that the use of G-CSF should be considered also for thyrostatic-induced agranulocytosis, because it may shorten this dangerous phase.
Faecal samples from 137 patients that had been shown to contain adenoviruses by electron microscopy were identified in a series of enzyme immunoassays (EIA) using a single monoclonal antibody (Mab) to adenovirus 40 and four different Mabs to adenovirus 41. Adenoviruses were partially characterised by restriction enzyme analysis (REA) of DNA extracts using SmaI. Samples were also run in a commercial EIA (Adenovirus IDEIA; Dako, Ltd.) which detects group antigen. The majority (84%) of adenoviruses were subgenus F: adenovirus type 41, 87 (64%) and adenovirus type 40, 28 (20.4%). Subgenus A viruses were identified in ten, (7%) patients, eight were type 31, and two type 12. The adeno IDEIA test was sensitive and specific, detecting 127 of 131 positives and giving no false-positive results with other enteric viruses. Use of monoclonal-based EIAs showed significant differences depending on which adeno 41 Mab was used, although the restriction patterns obtained using SmaI appeared to be identical for 66 of 69 samples that produced recognisable bands. The Mab that performed best, M 4.3.1, was raised against strains obtained from children in England and detected 83 of 84 (99%) of the adenovirus 41 samples tested. In contrast Mab JH/41 raised against the prototype strain of adenovirus 41 (Tak) detected only 69 of 87 (79%).
This study evaluated the postural vascular adjustment in the human forearm which may be responsible for the recent observation that transcapillary fluid balance is maintained above the level of the heart while blood flow decreases in a linear fashion. In this study further evidence was provided that a posturally graded profile of collapsed veins holds for both an overall increase of resistance with height and compensation for hydrostatic effects on capillary pressure. This was achieved by manipulating peripheral venous profile/volume: a proximal outlet resistance (upper arm cuff) was used for re-opening of collapsed distal veins. In test (a), 12 healthy subjects underwent recordings of fluid reabsorption rate and blood flow in a 20-cm segment of their forearm horizontally placed at 36 cm above heart level (third intercostal space). Applying upper arm cuff pressures randomly between 0 and 25 mmHg (0-3.33 kPa) for 15 min led to maxima of blood flow and reabsorption rates at inflations of 5 or 10 mmHg (0.67 or 1.33 kPa). This was attributed to minima in postcapillary resistance facilitating flow and reducing capillary pressure. In test (b) the flow-maximizing outlet resistance found was studied for its effect in different forearm positions (-18, 0, 18, 36, 54 cm relative to heart level). Blood flow then showed a shift of its maximum from heart level to 36 cm above heart level, while the reabsorption rate increased above 18-cm height--in contrast to previous findings with a free circulation. It was therefore concluded that the venous profile in the forearm adjusts postcapillary resistance in such a way that local dehydration is confined at the cost of blood supply. Thicker and less collapsable veins may ensure better flow autoregulation during impaired fluid balance--as seen in the legs.
To evaluate mechanisms of late orthostatic intolerance, slow fluid shifts along the body axis were studied during deconditioning by 24-h bed-rest and during 13-min upright tilts before and after this manoeuvre. In 11 healthy male subjects the fluid volumes of a thorax and a calf segment (impedance plethysmography) as well as tissue thickness at the forehead and the tibia (miniature ultrasonic plethysmograph) were recorded. Cardiovascular performance was monitored by recording heart rate (electrocardiogram), brachial and finger arterial pressure (by the Riva Rocci method and by the Finapres technique) as well as stroke volume (by impedance cardiography). Bed-rest led to a cephalad fluid shift with a mean interstitial leg dehydration of 2.2 ml.100 ml-1 with no changes in body mass and plasma volume. No syncope during the tilt occurred before bed-rest, while after bed-rest 8 subjects fainted between min 2.1 and 9.0 of the tilt. Bed-rest resulted in an augmented initial heart rate response to tilting which was similar in all subjects. In later orthostasis, bed-rest caused two- to threefold faster caudad fluid shifts with higher calf filtration rates in fainters (prior to hypotension) than in nonfainters. Through bed-rest the estimated extravasation within 10 min into general lower body tissue spaces increased by 192 ml in (late) fainters as opposed to only 23 ml in nonfainters. It was concluded that contributing factors to orthostatic intolerance may be slow transcapillary fluid shifts which are easily underestimated and whose quantity and time course call for further investigation after various deconditioning manoeuvres. In particular, the postflight fluid shifts in astronauts who will have markedly dehydrated legs, may impose a circulatory stress which needs to be evaluated. In general, the filtration rate in relevant areas appears to be an integrative and easily determined parameter, reflecting hormonal and neurogenic vascular as well as local interstitial control of the Starling forces.
The etiology of gastroenteritis was determined in children and adults with diarrhea seen at a district hospital and three government health clinics in Suan Phung, western Thailand, in 1991. Enteric viruses (rotavirus and astrovirus) were identified in 40%, shigellae in 18%, attaching and effacing Escherichia coli in 13%, Campylobacter jejuni in 9%, and enterotoxigenic E. coli in 7% of children < 5 years old with diarrhea seen at the hospital. Enteric viruses were detected in 15% (24/156) of patients with diarrhea > or = 5 years old and were the only enteric pathogens identified in 12 patients ages 7-79 years (2 astrovirus, 10 rotavirus infections). Attaching and effacing E. coli, rotavirus, and astrovirus were potential causes of diarrhea in children and adults in this population.
An important clinical endpoint in patients with cancer is formation of metastases in the brain. Understanding this phenomenon is important in several types of malignancies, including melanoma, lung and breast cancers. Metastatic tumor cells use specific adhesion molecules to home to brain, and there they must attach to microvessel endothelial cells and respond to brain endothelial cell-derived motility factors and brain invasion factors to invade the CNS. Neurotrophins are important invasion factors in this process, and the ability to invade into the brain may well depend on metastatic cell responses to neurotrophins and production of basement membrane-degradative enzymes capable of locally destroying the blood-brain barrier. Brain-metastatic human melanoma cells express low-affinity p75 receptor for neurotrophins such as nerve growth factor, but they do not express the high-affinity-type receptors for nerve growth factor encoded by the protooncogene trkA. Tumor cells can proliferate in the CNS in response to local paracrine growth factors and inhibitors, but their growth also depends on their producing and responding to autocrine growth factors. A major organ-derived (paracrine) growth factor has been isolated that differentially stimulates the growth of cells metastatic to the brain. Characterization of this mitogen demonstrated that it is a transferrin-like glycoprotein; cells that are metastatic to brain express greater numbers of transferrin receptors on their surfaces than cells that are poorly metastatic or metastatic to other sites. Transferrin-like factors are expressed in fetal brain and could represent the transferrin-like factors that stimulate growth of brain-metastatic melanoma and breast cancer cells. These and other factors are probably important in determining whether metastatic cells can successfully invade, colonize, and grow in the CNS.
A lactose-binding lectin from rat lung (RL-29) and a related lectin from Madin-Darby canine kidney (MDCK) cells have been analyzed with the primary goal of identifying post-translational modifications. The sequences show that RL-29 and the dog lectin are homologues of a lectin designated here as L-29 and elsewhere as CBP-35, epsilon BP, Mac-2, or L-34. RL-29 has a 140-amino-acid COOH-terminal carbohydrate-binding domain, a 20-amino-acid NH2-terminal domain, and an intervening domain consisting of 11 repeating elements rich in Pro, Gly, and Tyr (R-domain). The dog homologue has 14 repeating elements in its R-domain explaining its larger size. The sensitivity of the R-domain to bacterial collagenase allowed us to isolate the NH2-terminal domain and show that the NH2 terminus was blocked by acetylation and, in the accompanying paper (Huflejt, M. E., Turck, C. W., Lindstedt, R., Barondes, S. H., and Leffler, H. (1993) J. Biol. Chem. 268, 26712-26718), that the NH2-terminal domain is phosphorylated. In addition, we unexpectedly found an endogenous component, resembling 92-kDa type IV collagenase, that co-purified with L-29 and slowly digested the R-domain. Hence, L-29 is a substrate for bacterial and tissue collagenases even though the R-domain is non-collagenous. Moreover, the co-purification suggests a non-enzymatic interaction between 92-kDa collagenase and L-29.