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Biomedical subjects

K Klemm

Publications and source records attributed to K Klemm.

At least 19 recordsLinked to original sources

Local versus global interactions in nonequilibrium transitions: A model of social dynamics.

A nonequilibrium system of locally interacting elements in a lattice with an absorbing order-disorder phase transition is studied under the effect of additional interacting fields. These fields are shown to produce interesting effects in the collective behavior of this system. Both for autonomous and external fields, disorder grows in the system when the probability of the elements to interact with the field is increased. There exists a threshold value of this probability beyond which the system is always disordered. The domain of parameters of the ordered regime is larger for nonuniform local fields than for spatially uniform fields. However, the zero field limit is discontinous. In the limit of vanishingly small probability of interaction with the field, autonomous or external fields are able to order a system that would fall in a disordered phase under local interactions of the elements alone. We consider different types of fields which are interpreted as forms of mass media acting on a social system in the context of Axelrod's model for cultural dissemination.

Journal Article↗

[Early transfer from intensive care does not influence clinical results of carotid endarterectomy].

The purpose of this prospective observational study was to examine the necessity of intensive care after carotid endarterectomy (CEA). In consideration of the neurological stage and comorbidities, morbidity and mortality after early transfer from the intensive care unit (ICU) were examined. The CEA patients were assigned preoperatively to short or long monitoring. Those with symptomatic stenosis ranking > or =2 (stroke within 6 weeks before surgery) and ischemic areas in cCT were observed overnight (long) in the ICU. Within 5.5 months, 100 consecutive patients had received 107 CEAs. Preoperatively, seven of these (6.54%) were assigned to ICU overnight monitoring. 14 patients (13%) needed postoperative over night ICU. We observed no perioperative stroke or mortality in the 107 consecutive CEAs. We could not detect any risk factor in preoperatively determining the length of postoperative ICU monitoring. This prospective, single center study showed that, after CEA, it is safe to monitor patients for only a short period (4-8 h) in the ICU. Morbidity and mortality after early transfer to the regular ward did not increase.

Adult↗

Improvement of carotid blood flow after carotid endarterectomy--evaluation using intraoperative ultrasound flow measurement.

OBJECTIVES: to examine the relationship between the degree of extracranial internal carotid artery (ICA) stenosis and changes in the ipsilateral ICA blood flow after carotid endarterectomy (CEA). MATERIALS AND METHODS: in a prospective study we studied 51 patients with unilateral 60-99% ICA stenosis (median degree 84%, asymptomatic stenosis n = 13, symptomatic stenosis n = 38). The degree of ICA diameter stenosis was determined by ex-vivo plastination of the surgically removed atherosclerotic specimen and video-assessed planimetry. Intraoperative transit time ultrasound flow measurements of the carotid arteries were performed before and after CEA. Blood flow changes were assessed by mathematical approximations. Statistics were done by use of the Wilcoxon signed Rank test. RESULTS: common carotid artery (CCA) and ICA median blood flow increased after CEA from 370 and 130 ml/min to 450 and 282 ml/min, respectively (p <.001). The relative increase of ICA blood flow was 5% and 18% for 60-69% and 70-79% ICA stenosis (n.s.) but 70% and 247% for 80-89% and 90-99% stenosis (p <.001 each). Mathematical evaluation (fourth-polynomal function) determined a significant increase of carotid blood flow after CEA in ICA stenosis of > or =82.3%. CONCLUSIONS: in the absence of severe contralateral ICA occlusive disease a significant increase of ipsilateral ICA blood flow by CEA can be expected in patients with an ICA stenosis of > or =82.3% (linear degree of stenosis, ECST criteria).

Aged↗

XX male: a rare cause of short stature, infertility, gynaecomastia and carcinoma of the breast.

We present a case of an XX male with carcinoma of the breast and primary infertility. He was admitted to hospital with recurrent chest pains, but a history of surgery for breast carcinoma, gynaecomastia and the finding of bilaterally atrophied testes, coupled with the fact that he had never fathered children, necessitated further investigations. Chromosomal analysis showed a 46, XX male genotype with a normal X chromosome and an abnormal X chromosome formed by translocation between the short arm of one X chromosome and the Y chromosome. By using fluorescence in situ hybridisation, the patient proved to be SRY positive, the sex-determining region of the Y chromosome. In this rare genetic abnormality, males retain normal phenotype but they are generally of short stature, have gynaecomastia, and may have genital anomalies. They are infertile and at increased risk of developing carcinoma of the breast. This seems to be the first documented case of carcinoma of the breast in an SRY positive XX male. This particular case illustrates the need for all cases of male breast cancer to undergo full endocrinological assessment, especially in the presence of genital anomaly or infertility.

Aged↗

The Carotid Surgery for Ischemic Stroke trial: a prospective observational study on carotid endarterectomy in the early period after ischemic stroke.

OBJECTIVE: The purpose of this study was to examine the safety of carotid endarterectomy (CEA) within 6 weeks after a nondisabling carotid-related ischemic stroke. Endpoints were the perioperative stroke or mortality rate and the incidence rate of cerebral bleedings. METHODS: This prospective observational multicenter trial was performed in community and university centers. One hundred sixty-four hospitalized patients with nondisabling carotid-related ischemic stroke were included. The patients were identified clinically with the modified Rankin scale (initial neurologic deficit grade >/= 2, n = 160). Four patients with evidence of ischemic territorial infarction on cerebral computed tomographic (CT) scan but no persisting functional deficit were also included. CEA was performed within 6 weeks after stroke. Neurologic examinations were performed initially, before surgery, 3 days after surgery, and 6 weeks after CEA. Worsening of more than 1 grade on the Rankin scale was considered as a new stroke or stroke extension. Unenhanced CT scans of the brain were performed before and after surgery. CT scans were evaluated blind to clinical patient data. Statistical analysis included univariate and multivariate analysis. RESULTS: The combined stroke or mortality rate within 30 days after CEA was 6.7%. Ten patients had a new ipsilateral stroke or stroke extension, and one patient died after surgery of a myocardial infarction. One patient (0.6%) had parenchymatous cerebral bleeding, and in 10 patients, hemorrhagic transformation within the preexisting ischemic infarction was detected but no infarct extension was observed. In the multivariate analysis, American Society of Anesthesiology (ASA) grades III and IV and decreasing age were significant predictors for an increased perioperative risk. Patients with a higher risk profile (ASA classification grades III and IV) had a high perioperative risk when CEA was performed within the first 3 weeks (14.6% versus 4.8% beyond 3 weeks). Patients without severe concomitant diseases (ASA grades I/II) had a low perioperative risk of 3.4% if CEA was performed within the first 3 weeks. CONCLUSION: Early CEA within 6 weeks after a carotid-related ischemic stroke can be performed with a perioperative stroke or mortality rate comparable with the results reported in the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial. The risk of parenchymatous bleeding is low. ASA grades III and IV and decreasing age were predictive of an increased perioperative risk, especially if CEA was performed within the first 3 weeks. Patients at low risk can undergo operation safely within the first 3 weeks. Individual patient selection in an interdisciplinary approach between neurologists, anesthesiologists, and vascular surgeons remains mandatory in these patients.

Aged↗

The use of antibiotic-containing bead chains in the treatment of chronic bone infections.

The implantation of gentamicin polymethylmethacrylate (PMMA) chains or minichains into infected osteomyelitic cavities is a well-established local antibiotic therapy supplementary to radical debridement. The gentamicin concentrations achieved at the site of infection are far above the MICs for most common pathogens in chronic osteomyelitis. Serum and urine concentrations are low, and nephrotoxic and ototoxic side-effects of this form of gentamicin application are not to be feared. Under local antibiotic therapy with gentamicin PMMA chains, primary wound healing as in aseptic surgery can be expected. Prolonged systemic antibiotic therapy is unnecessary. In a series of 405 cases, a success rate of 90.4% was obtained.

Anti-Bacterial Agents↗

Grading of internal carotid artery stenosis: validation of Doppler/duplex ultrasound criteria and angiography against endarterectomy specimen.

OBJECTIVES: duplex ultrasound has replaced angiography prior to carotid endarterectomy (CEA) in many institutions. However, the indications for CEA are based on angiographically controlled studies and widely accepted ultrasound criteria do not exist. Consequently, the reliability of Doppler and/or duplex ultrasound to predict a high-grade ICA stenosis has to be proven. DESIGN: prospective validation study. MATERIALS: one hundred and fifty carotid bifurcations assessed by ultrasound and selective angiography and 68 acrylat outcasts of carotid specimen after eversion CEA. METHODS: ICA stenosis was measured angiographically according to the ECST criteria. Combined Doppler acoustic standard criteria (CDASC), peak systolic frequency (PSF), peak systolic velocity (PSV) and end-diastolic velocity (EDV) served as criteria for the ultrasound assessment. These criteria and the results of angiography were compared to the degree of ICA stenosis determined by specimen measurements. RESULTS: the median degree of ICA stenosis as assessed by angiography (82%, range 56-97%) and CDASC (83%, range 50-99%) corresponded well to the specimen measurements (80%, range 50-95%). The sensitivity of angiography and CDASC to predict a 70-90% ICA stenosis (ECST criteria) compared to the specimen measurements was 88% and 95%, respectively. The positive predictive value (PPV) reached 92% and 96%, respectively. CDASC were equivalent to angiography and were superior to the best single frequency or velocity parameters. If CDASC do not indicate a >/=70% ICA stenosis in spite of a PSV >/=180 cm/s and/or an EDV >/=50 cm/s, angiography may detect patients with a >70% ICA stenosis. CONCLUSIONS: CDASC are valid in the quantification of high-grade ICA stenosis. They are more reliable than single velocity and/or frequency measurements. However, if velocity criteria and CDASC do not agree, angiography should be performed.

Angiography↗

Beyond Hebb: exclusive-OR and biological learning.

A learning algorithm for multilayer neural networks based on biologically plausible mechanisms is studied. Motivated by findings in experimental neurobiology, we consider synaptic averaging in the induction of plasticity changes, which happen on a slower time scale than firing dynamics. This mechanism is shown to enable learning of the exclusive-OR (XOR) problem without the aid of error backpropagation, as well as to increase robustness of learning in the presence of noise.

Brain↗

Adult posttraumatic osteomyelitis of the tibial diaphysis of the tibial shaft.

Osteomyelitis of the diaphysis of the tibia in adults is an uncommon but disabling condition. It occurs principally in patients with complex fractures of the tibial shaft in which devitalized bone becomes infected either with a single strain of a virulent organism or with multiple organisms. The outcome of treatment depends on the assessment and management of three interrelated factors, which are the vitality and stability of the bone, the virulence and antibiotic susceptibility of the infecting organism, and the condition of the soft tissues. The impact of the infection on the patient's vitality is of great importance. Successful management depends on control of inflammation, excision of dead bone, and stabilization of the skeleton. Interlocking nailing and local antibiotic treatment are particularly successful strategies. In the future, modification of the inflammatory response with local tissue mediators may become an important adjunctive therapy.

Adult↗

Regional intestinal blood flow and nitric oxide synthase inhibition during sepsis in the rat.

OBJECTIVE: Regional circulatory changes in intestinal mucosa were evaluated after the onset of septic shock and the effect of nitric oxide (NO) inhibition on mucosal blood flow was investigated at different locations along the intestine. SUMMARY BACKGROUND DATA: The response of intestinal blood flow to different physiologic and pharmacologic stimuli is known to vary along the intestine, but limited data are available on regional alterations in intestinal blood flow during septic shock. These regional variations in intestinal blood flow could become important because NO inhibition might restore the circulation of one segment of the gut or exacerbate ischemia that may be occurring concomitantly in another segment of the intestine. METHODS: Mucosal blood flow was studied with fluorescent microspheres in conscious unrestrained rats before and 2, 4, and 6 hours after lipopolysaccharide (LPS, 20 mg/kg intraperitoneally) induced sepsis in the presence and absence of the nitric oxide synthase inhibitor N(G)-nitro-L-argininemethylester (L-NAME, 5 mg/kg subcutaneously). RESULTS: Control mucosal blood flow was significantly higher in the ileum than in the duodenum, jejunum, or colon. During LPS-induced sepsis, mucosal blood flow to the ileum decreased and perfusion to the remaining gut was preserved. This was accompanied by hypotension throughout the experiment. L-NAME administration during sepsis prevented hypotension and decreased mucosal blood flow to all segments of small intestine at 2 hours. In this group, mucosal blood flow to the proximal small intestine but not to the ileum returned to baseline levels at 4 and 6 hours. L-NAME alone decreased mucosal blood flow to the small intestine throughout the experiment. CONCLUSIONS: This study indicates that mucosal blood flow alterations during septic shock vary along the intestine, with a significant change only in the ileum, suggesting that perfusion in the small intestine is dependent on physiologic NO production.

Animals↗

[Computer-based training exemplified by the carotid artery].

The purpose of computer-based training (CBT) is interactive use of multimedia components, such as text, graphics, animation, sound, digital slide shows, and videos. This CD-ROM illuminates different aspects of carotid surgery: cerebrovascular insufficiency, sonographic and neuroradiological diagnostics, indications and results of carotid surgery in the literature, perioperative complications and new developments such as interventional procedures. Digital imaging (60 minutes of video sequences and 250 graphics) especially focus on operative standard procedures (conventional and eversion technique) and alternative methods. CBT is an evolving supplement to improve education programs in vascular surgery.

CD-ROM↗

Effects of the selective bisindolylmaleimide protein kinase C inhibitor GF 109203X on P-glycoprotein-mediated multidrug resistance.

Inhibition of protein kinase C (PKC) is discussed as a new approach for overcoming multidrug resistance (MDR) in cancer chemotherapy. For evaluation of this concept we applied the bisindolylmaleimide GF 109203X, which shows a highly selective inhibition of PKC isozymes alpha, beta 1, beta 2, gamma, delta and epsilon in vitro. The efficacy of this compound in modulation of MDR was examined using several P-glycoprotein (P-gp)-overexpressing cell lines including a MDR1-transfected HeLa clone, and was compared with the activities of dexniguldipine-HCI (DNIG) and dexverapamil-HC1 (DVER), both of which essentially act via binding to P-gp. As PKC alpha has been suggested to play a major role in P-gp-mediated MDR, cell lines exhibiting different expression levels of this PKC isozyme were chosen. On crude PKC preparations or in a cellular assay using a cfos(-711)CAT-transfected NIH 3T3 clone, the inhibitory qualities of the bisindolylmaleimide at submicromolar concentrations were demonstrated. At up 1 microM final concentrations of the PKC inhibitor GF 109203X, a concentration at which many PKC isozymes should be blocked substantially, no cytotoxic or MDR-reversing effects whatsoever were seen, as monitored by 72 h tetrazolium-based colorimetric MTT assays or a 90 min rhodamine 123 accumulation assay. Moreover, depletion of PKC alpha by phorbol ester in HeLa-MDR1 transfectants had no influence on rhodamine 123 accumulation after 24 or 48 h. MDR reversal activity of GF 109203X was seen at higher final drug concentrations, however. Remarkably, [3H]vinblastine-sulphate binding competition experiments using P-gp-containing crude membrane preparations demonstrated similar dose dependencies as found for MDR reversion by the three modulators, i.e. decreasing efficacy in the series dexniguldipine-HCl > dexverapamil-HCl > GF 109203X. Similar interaction with the P-gp in the micromolar concentration range was revealed by competition of GF 109203X with photoincorporation of [3H]azidopine into P-gp-containing crude membrane preparations. No significant effect of the PKC inhibitor on MDR1 expression was seen, which was examined by cDNA-PCR. Thus, the bisindolylmaleimide GF 109203X probably influences MDR mostly via direct binding to P-gp. Our work identifies the bisindolylmaleimide GF 109203X as a new type of drug interacting with P-gp directly, but does not support the concept of a major contribution of PKC to a P-gp-associated MDR, at least using the particular cellular model systems and the selective, albeit general, PKC inhibitor GF 109203X.

3T3 Cells↗

Cholecystokinin-induced protection against gastric injury is independent of endogenous somatostatin.

Cholecystokinin (CCK) prevents macroscopic injury to the stomach from luminal irritants by an unknown mechanism. The present study was undertaken in conscious rats to ascertain what role gastric mucosal blood flow, sensory neurons, and endogenous somatostatin play in CCK-induced gastric protection. Subcutaneous administration of CCK (10-100 micrograms/kg) significantly reduced macroscopic injury to the acid-secreting portion of the stomach caused by 1 ml of orally administered acidified ethanol (150 mM HCl, 50% ethanol) and augmented gastric mucosal blood flow (fluorescent microspheres) in a dose-dependent fashion. However, although the protective response to CCK (100 micrograms/kg) was still present at 2 h, the blood flow response had returned to baseline by 45 min. Ablation of capsaicin-sensitive afferent neurons with capsaicin (125 mg/kg sc) did not negate CCK-induced protection. Pretreatment with exogenous somatostatin (1 pmol-1 nmol/kg sc) failed to prevent the damaging effects of acidified ethanol to gastric mucosa. Immunoneutralization of endogenous somatostatin with somatostatin monoclonal antibody (2 mg ip) did not reverse the protective actions of CCK. Thus the data suggest that although CCK may prepare the gastric mucosa to withstand a damaging insult by augmenting gastric mucosal blood flow, its protective mechanism is independent of intact sensory neurons and endogenous somatostatin.

Animals↗

Hemorrhagic shock increases gut macromolecular permeability in the rat.

The effect of hemorrhagic shock on gut permeability to macromolecules was investigated using fluorescein isothiocyanate dextrans (4,300 or 73,100 daltons). These were given orally, then measured in systemic blood during hemorrhage (mean arterial pressure of 30 mmHg) and reperfusion; sham-shocked animals served as controls. Hemorrhage lasting 2 h resulted in a 5-fold increase in concentration of both tracers relative to that found in control groups. Reperfusion reduced these differences, with values approximately threefold greater than those of controls after 2 h. On a molar basis, the smaller molecule was more permeant than the larger one. This study provides evidence that hemorrhagic shock physically perturbs the normal barrier function of the mucosa, permitting very large substances in the gut lumen access to the circulation. It may further explain, at least in part, previous observations that hypovolemic shock results in bacterial translocation and endotoxemia.

Animals↗

A flow sheet for follow-up after chemotherapy extravasation.

PURPOSE/OBJECTIVES: To introduce and describe the development and implementation of a flow sheet used to document patient follow-up after chemotherapy extravasation. DATA SOURCES: Published articles, institutional standards of nursing practice, and the Oncology Nursing Society Cancer Chemotherapy Guidelines. DATA SYNTHESIS: Extravasation is a potentially serious and severe complication of vesicant chemotherapy administration. A tool was designed to streamline documentation of patient symptoms, nursing interventions, patient education, and follow-up care after a suspected or actual extravasation. CONCLUSIONS: The flow sheet improves nursing documentation after a suspected or actual vesicant chemotherapy extravasation and provides a consistent, concise method for monitoring extravasations over time. IMPLICATIONS FOR NURSING PRACTICE: The flow sheet standardizes nursing assessment, intervention, patient education, and follow-up care after a suspected or actual chemotherapy extravasation. Use of the flow sheet saves time and improves consistency of nursing documentation.

Antineoplastic Agents↗

B9209-005, an azido derivative of the chemosensitizer dexniguldipine-HCl, photolabels P-glycoprotein.

P-glycoprotein is an energy-dependent drug extrusion pump for a variety of anticancer drugs and is involved in the development of multidrug resistance in cancer. Dexniguldipine-HCl is a potent chemosensitizer for P-glycoprotein-mediated multidrug resistance in vitro, and clinical phase I/II trials are underway. To investigate the mechanisms of chemosensitization and to identify the binding sites for dexniguldipine-HCl on target proteins involved in chemosensitization, [3H]B9209-005, an azido derivative of dexniguldipine-HCl, was synthesized and used as a photoaffinity ligand. In two models of multidrug resistance reversal, i.e., sensitization to vincristine and modulation of rhodamine-123 uptake, B9209-005 and dexniguldipine-HCl showed identical biological activities. Photoaffinity labeling experiments with [3H]B9209-005 in cell membranes from multidrug-resistant CCRF ADR-5000 cells, in comparison with labeling experiments with [3H]azidopine (an established photoaffinity ligand for P-glycoprotein), showed that [3H]B9209-005 labeled two proteins, with apparent molecular masses of 170 and 95 kDa. The pharmacological specificity of labeling was demonstrated by inhibition of photoincorporation by several cytostatic drugs transported by P-glycoprotein, as well as by chemosensitizers. Immunoprecipitation of the labeled proteins with the P-glycoprotein-specific monoclonal antibody C 219 and with a site-directed polyclonal antibody to the amino-terminal sequence of P-glycoprotein (amino acids 389-406) identified these proteins as intact P-glycoprotein and the amino-terminal fragment thereof. No specific labeling was obtained in the drug-sensitive parent cell line CCRF-CEM, which is devoid of significant P-glycoprotein expression. Maximal labeling of 17 pmol of the 170-kDa protein/mg of crude membrane protein was obtained. The affinity of [3H]B9209-005 for binding to and photoincorporation into P-glycoprotein was 5-fold greater than that of [3H]azidopine, and photoincorporation of [3H]B9209-005 showed a different photoincorporation pattern, compared with [3H]azidopine, in that the latter compound was incorporated specifically into the carboxyl-terminal 55-kDa fragment of P-glycoprotein. In contrast to [3H]azidopine, no specific labeling of this fragment was obtained with [3H]B9209-005, indicating different binding sites for or different photoincorporation of the two dihydropyridine ligands. Because B9209-005 carries the photoreactive azido group in the dihydropyridine moiety, whereas the azido group of azidopine is located in the side chain, these results suggest that the dihydropyridine moiety of the two compounds probably interacts with the amino-terminal part of P-glycoprotein, whereas the side chains react preferentially with the carboxyl-terminal 55-kDa fragment.(ABSTRACT TRUNCATED AT 400 WORDS)

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Use of antibiotic-PMMA beads in the ischemic foot.

Thirty-six patients with 44 ischemic foot infections were managed with antibiotic-polymethylmethacrylate (PMMA) beads. Most of these patients received gentamicin-impregnated PMMA beads but tobramycin and vancomycin-impregnated PMMA beads were used on three patients. Angiopathy occurred in 35 patients secondary to diabetes and secondary to renal disease in 2; 1 patient had both diabetes and renal disease. The most common bacteria was Staphylococcus aureus (82%), although other organisms and multiple bacteria were present. In spite of the variability of the bacteria, PMMA beads were helpful in managing foot infections in this difficult patient population.

Anti-Bacterial Agents↗

Primary structure differences of human surfactant-associated proteins isolated from normal and proteinosis lung.

The primary structures of human pulmonary surfactant-associated proteins SP-A, SP-B and SP-C isolated from lung lavage of patients with alveolar proteinosis exhibit significant differences from lung surfactant proteins isolated from lungs of healthy individuals. In contrast to SP-A from normal lungs, proteinosis SP-A was shown by SDS gel electrophoresis to contain large amounts of unreducibly cross-linked beta chains. Specific primary structure modifications of SP-C and SP-B proteins were established by direct molecular weight and structural analysis, using [252Cf]plasma desorption mass spectrometry (PD/MS) as the principal method. In comparison to normal lung surfactant SP-B, proteinosis SP-B showed a significantly increased molecular weight by approx. 500 Da for the unreduced protein dimer. SP-C proteins from normal lungs were identified to possess a bis-cysteinyl-5,6-(thioester)palmitoylated structure, and to contain a frayed N-terminus resulting in two sequences of 34 and 35 amino acid residues. In contrast, SP-C from proteinosis patients was modified by (i) partial or even complete removal of palmitate residues and (ii) additional N-terminal proteolytic degradation. These results indicate the presence of pathophysiological structure modifications, which are likely to occur in the alveolar space, and may lead to a reduced surfactant function.

Amino Acid Sequence↗