Therapy of subhyaloidal hemorrhage by intravitreal application of rtPA and SF(6) gas.
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Biomedical subjects
Publications and source records attributed to K Schmitz.
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Ample evidence has been provided concerning the presence of tenascin in various histological subtypes of gastric cancer. However, conflict and discussion still persist regarding the correlation with different classification systems and prognostic impact. Therefore, we studied 203 adenocarcinomas of the stomach with special emphasis to the WHO-classification, Lauren's and Goseki's subtypes as well. The immunohistochemical ABC-method was applied using a monoclonal anti-human-tenascin antibody. 30% of all tumours showed a distinct staining reaction. Tubulo-papillary carcinomas (WHO) revealed a significantly stronger reactivity than signet-ring subtypes. Adenocarcinomas of intestinal type (Lauren) were significantly more positive than the diffuse types. Mucin-poor tumours (Goseki I+III) stained positive in a much higher degree compared to mucin-rich subtypes (Goseki II+IV). However, no correlation could been demonstrated regarding TNM-stage or prognosis.
PURPOSE: To evaluate the concentration and kinetics of dorzolamide in the aqueous humor after its topical application. METHODS: Samples of aqueous humor were collected at the beginning of routine cataract surgery at defined intervals after topical application of a 2% solution of dorzolamide. After deep-frozen storage of the samples, drug extraction was achieved with a mixture of solvents. Quantification was carried out by high-performance liquid chromatography on a reversed-phase column. RESULTS: Peak concentrations of dorzolamide in aqueous humor were reached approximately 2 hours after application with 1000 ng/ml. Average values were approximately 1000 to 700 ng/ml after 4 to 6 hours and approximately 200 ng/ml after 12 hours. Mean half-life of absorption was 1.2 hours and for elimination 3.0 hours. CONCLUSIONS: Pharmacokinetics of dorzolamide in the aqueous humor of humans are in comparable dimensions as previously reported in experimental trials in pigmented rabbits. There is a clear linear absorption and elimination kinetic, which is demonstrated using the Bateman function. A better knowledge of the distribution and kinetics of dorzolamide will help to explain its reported effects on intraocular hemodynamics, distinct from its intraocular pressure lowering effect.
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Evidence in animal intermediate hosts that susceptibility to larval infection with Echinococcus multilocularis is restricted to individual host factors prompted us to investigate the susceptibility markers in humans. Because antigens of the extracellular parasite E. multilocularis are possibly presented by MHC molecules in a restricted way, we speculated that MHC polymorphism may influence resistance of the host towards infection and course of disease. We studied HLA-A, -B, -DRB1, -DQB1 and -DPB1 polymorphism in 151 patients with alveolar echinococcosis. Patients with an observation period of more than 2 years were grouped according to the clinical follow-up into cured (no recurrence following surgery) patients and patients with regressive or progressive forms of disease during benzimidazole chemotherapy. By comparing phenotypic frequency between patients with alveolar echinococcosis and healthy controls, HLA-DRB1*11 was associated with a reduced risk for disease development (odds ratio=0.55, 95% confidence interval=0.34-0.88; P=0.01). HLA-DQB1*02 was more frequent in patients with progressive disease when compared with patients with regressive disease (54.3% vs 28.3%, P=0.02). The result suggests that HLA-DRB1*11 might confer protection against alveolar echinococcosis and that HLA-DQB1*02 may indicate a risk for progressive disease development. The findings may facilitate the search for immunodominant T-cell epitopes of E. multilocularis.
The present study investigated (i) the relationship between standardised morphometric AgNOR parameters (argyrophilic nucleolar organiser region-associated proteins) and MIB1 growth fraction, and (ii) their correlation with immunohistochemical p53, sex steroid receptor status and histopathological differentiation grade in serial paraffin sections from 39 breast carcinomas. Ten sections were double-stained for AgNOR/MIB1. AgNOR parameters correlated significantly with MIB1 growth fraction and p53 protein expression. Significant inverse correlation was found between proliferation markers and oestrogen/progesterone receptor status and histopathological grade. AgNOR expression was significantly higher in cycling (MIB1 positive) tumour cells, than in resting (MIB1 negative) ones, however with exceptions. We conclude, that standardised AgNOR parameters correlate with markers of increased malignant potential in breast carcinomas. However, AgNORs seem to reflect proliferation independent cellular and nucleolar activity of tumour cells, as well. We recommend the use of standardised AgNOR analysis for obtaining sound results in routine paraffin sections.
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We report on our first two patients treated by intracameral application of tissue plasminogen activator (tPA) for dissolving fibrinous exsudates. Both patients had developed fibrin membranes in the pupillary plane and in the anterior chamber several days after cataract surgery. Injection of 25 micrograms tPA into the anterior chamber resulted in complete dissolution of the fibrin within 1 h of its application.
We conducted a descriptive study to determine the relationship between prenatal risk and birth outcomes in the antepartal caseloads of rural public health nurses. A convenience sample of 41 low-income pregnant women was assessed for prenatal risk by the nurses at the time of admission and again after 32 weeks' gestation. Birth outcome data were collected from maternal and infant hospital medical records. Analysis of the difference in mean scores from the first to the second assessment indicated a statistically significant change in the prenatal psychosocial risk score (P = 0.000) after public health nursing care. Physiologic and psychosocial risks at both assessment points were related to only one infant outcome measure: the 5-minute Apgar score. Psychosocial risk in late pregnancy accounted for 22% of the variance in 5-minute Apgar scores.
The need to integrate clinical practice and research has been stressed for many years in both public health and nursing. This article describes such a collaborative project between two rural upper Midwest public health nursing agencies and public health nursing faculty from a small, liberal arts, baccalaureate nursing program. The high-risk prenatal research project provided an opportunity for nursing staff and faculty research consultants to work together on a clinical study. A model for collaborative research is illustrated, and advantages and disadvantages for practice, administration, and research are discussed.
In a retrospective study of the records of 64 patients with AIDS and cytomegalovirus (CMV) retinitis, 47 patients were evaluated regarding the effectiveness of initial virustatic therapy, and 41 patients regarding the anatomical and functional long-term development (maintenance therapy, rate and intervals of recurrences, complications, adverse drug reactions, time of survival, and visual outcome). The average survival time of 45 treated patients was 226 days (31-717 days). More than 90% responded to initial therapy with ganciclovir or foscarnet. Forty-four percent remained free of recurrences until they died (for up to 15 months); 56% had 1 to 4 recurrences, altogether 35 episodes, of which 14 occurred after withdrawal of therapy. Recurrences were treated with high-dose reinduction therapy with good or partial response in more than 80% of cases. Nine patients showed "smouldering retinitis" at a late stage. Two out of 45 patients became blind shortly after diagnosis despite therapy; both showed a course mimicking acute retinal necrosis syndrome with histologically proven CMV disease. None of the 43 patients on maintenance therapy for up to 2 years became blind in both eyes. Only 2 out of 43 patients had a poor visual outcome < 40/100 in the better eye at a late disease stage. Of 60 affected eyes, 11 showed retinal detachment, 14 eyes developed optic atrophy and 12 eyes became blind. Our retrospective study shows that consistent maintenance therapy of patients with CMV retinitis prevents severe deterioration of visual acuity in most cases even in long disease courses and thus maintains quality of life.
Toxoplasmosis-retinochorioiditis is the second most frequent opportunistic infection of the eye among our series of AIDS patients. Between 1985 and 1990 we diagnosed 7 cases in 261 AIDS patients (Walter Reed classification 6); prevalence = 2.7%). The incidence has been increasing over the years. In four cases, toxoplasmosis was restricted to the eye, in three cases, ocular disease occurred combined with toxoplasmosis of the central nervous system. Since serological findings are not very reliable in AIDS-patients, the most important element in the differential diagnosis against retinitis of different etiology is ophthalmoscopy. There are a number of findings which allow differentiation of toxoplasmosis from other forms of retinitis, especially cytomegalovirus retinitis. Toxoplasmosis-retinitis was stopped in all cases by administering a specific therapy of pyrimethamine combined with clindamycin, a sulfonamide or spiramycin. Stable scar formation was achieved after 2-3 weeks therapy. Subsequent maintenance therapy with Fansidar (pyrimethamine + sulfadoxine) protected 4/4 patients from a relapse, while maintenance therapy with pyrimethamine alone allowed a relapse in 1/2 patients.
We have developed a highly sensitive in vitro bioassay for lymphotoxin (LT) and tumor necrosis factor (TNF). This system employs a monolayer of 20,000 L-929 target cells in each well of 96-well microplates that are incubated in dilutions of LT and TNF at 37 degrees C for 20-24 h, after which the viability of the L-929 target cells is assessed by spectrophotometric techniques. We find that incorporation of 2 mM NaF increases the sensitivity of L-929 cells to lysis by 10(3)-10(4) x for LT and 10(4)-10(5) x for TNF. This method allows the regular detection of less than 1-5 pg of bioactive protein. ELISA assays did not detect synthetic TNF and TNF fragments that were not biologically active in this assay. The L-929 bioassay requires no isotopes, is very reproducible, is as sensitive as ELISA techniques, and detects only biologically active LT and TNF.
There is a paucity of research on the effectiveness of inpatient treatment of conduct disorders. The purpose of the present study was to determine what effect a locked behavioral/cognitive treatment setting would have upon the Minnesota Multiphasic Personality Inventory (MMPI) and Jesness Inventory scores of adolescent inpatients. Fifty consecutive admissions (30 males, 20 females) to a conduct disorders unit were administered the MMPI and Jesness Inventory pre- and posttreatment. Statistically significant changes were found on both inventories. Males responded to treatment more favorably than did females. Improvement on the test scores could not conclusively be linked to the treatment due to the absence of a control group; however, combined with previous research, the results indicate areas of improvement in the sample's pathology.
A new method of investigating the efficacy of regional thermotherapy in subcutaneous xenografts of nude mice is reported. The use of high frequency hyperthermia was well tolerated by the sensitive animals and allowed an exact continuous temperature measurement in different tumor regions. The interstitial procedure in this model could be the best approach for later clinical use in urology, e.g. for prostate treatment and is an alternative to the transrectal hyperthermia application.
Multi-course sequential learning (MCSL), a model for integrating content throughout the curriculum, is described using ethics education as a prototype. In this model, content is presented via a vertical course, with units embedded in existing courses across various levels of the nursing program, which is designed to provide coherent organization of content, visibility, and accountability, and to prevent gaps and unnecessary duplication. This article describes the process of developing an Ethics MCSL, which is being implemented and evaluated with support from a three-year grant from the Fund for the Improvement of Postsecondary Education (FIPSE).