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Biomedical subjects

M Bauer

Publications and source records attributed to M Bauer.

At least 487 records · Page 27Linked to original sources

Filamentous phage morphogenetic signal sequence and orientation of DNA in the virion and gene-V protein complex.

The circular single-stranded viral DNA (ssDNA) of filamentous phage is oriented in the virus with a hairpin forming sequence called mos at the leading end of the virion-the end that emerges from the cell first. In the experiments that originally defined mos it was also found to enhance virion production 100-fold, though in other circumstances it has no such effect. Using a new electron-microscopic method, we have ascertained the orientation of ssDNA in phage having mutations involving mos and other viral functions, and also in the intracellular precursor to the virion-a rod-shaped complex between the ssDNA and the phage-encoded gene-V protein, pV. The results show (1) that the ssDNA is oriented in the complex as in the virion, with mos at one end; (2) that orientation is maintained even if assembly is not mediated by the complex; (3) that orientation is manifested in polyphage--abnormal particles in which many unit-length ssDNA molecules are sheathed in a single, extremely long capsid; (4) that orientation is imposed by mos itself (or something very nearby) since it disappears in a mos deletion; and (5) that a 229-base segment including the minus strand of mos is also effective at imposing orientation. On the basis of our findings, we speculate that mos determines orientation in two stages, one imposing an axis on the ssDNA loop during formation of the pV/ssDNA complex, the other imposing a direction on the loop during initiation of particle assembly. The sequence requirements for the two stages may be different.

Bacteriophages↗

Post-operative thoracic irradiation with or without levamisole in non-small cell lung cancer: results of a Radiation Therapy Oncology Group Study.

The Radiation Therapy Oncology Group conducted a Phase III single blind trial to evaluate the addition of Levamisole to post-operative thoracic irradiation (200 cGy five times weekly to a total of 5000 cGy plus 1000 cGy boost) in patients with resected RTOG Stage II-III non-small cell lung cancer with positive nodes. Between February 1980 and February 1983, 74 patients from 18 RTOG institutions were randomized; accrual to this study was prematurely terminated due to poor accrual and the inferior survival observed in the levamisole-treated patients on another RTOG trial. Sixty-four patients were evaluable; 32 assigned to levamisole and 32 were assigned to placebo. Over 95% of the patients have been followed for a minimum of 4 years or to death. Two patients on placebo and 5 on levamisole experienced Grade 3 pneumonitis or esophagitis; 1 patient on placebo and 2 on levamisole experienced Grade 3 pulmonary fibrosis. Three patients on levamisole experienced other Grade 3 or 4 toxicity: 1 case of intractable nausea and vomiting and 2 with Grade 4 neutropenia (less than 500 per mm3). There were no fatal complications. Median disease-free survival was 13 months in the placebo group and 9 months for the levamisole group. Median time to distant metastases was 18 and 12 months, and median survival was 20 and 13 months, respectively. We concluded that this study failed to demonstrate an advantage for levamisole.

Adult↗

Thoracic irradiation with or without levamisole (NSC #177023) in unresectable non-small cell carcinoma of the lung: a phase III randomized trial of the RTOG.

A total of 285 patients with medically inoperable (RTOG Stage T1-2, N0-1) or unresectable (RTOG Stage T3, N0-1) non-small cell carcinoma of the lung were randomized by the Radiation Therapy Oncology Group (RTOG) to receive radiation therapy (6000 cGy total dose/6 weeks) plus levamisole (2.5 mg/kg twice weekly for 2 years or until tumor progression) or a placebo. One hundred twenty-nine evaluable patients were assigned to placebo and 131 to levamisole. This report is based on 260 (91%) eligible patients who started treatment and have adequate follow-up. Fifty percent of the patients in both treatment groups had Karnofsky scores of 90-100; 72% had squamous cell carcinoma, 12% adenocarcinoma, and 16% large cell undifferentiated carcinoma; 60% had RTOG Stage I or II primary tumors and 40% had Stage III (T3, N0-1) tumors. Complete regression of tumor was reported in 20% of the patients treated with levamisole and 36% of those receiving placebo. An additional 33% and 19%, respectively, had a partial response (trend test p = 0.08). Median survival was 9 months for patients treated with levamisole and 12 months for those on placebo (two-sided p less than 0.01); at 2 years, patients treated with levamisole had a 15% survival rate as compared to 24% in those receiving placebo. The cumulative proportion failing within the irradiated field with or without other sites of progression at 2 years was 30% in the levamisole group and 34% in the placebo patients. Median progression-free survival was 6 months for patients on levamisole and 7 months for those on placebo (overall two-sided p = 0.014); the estimated proportions progression-free at 2 years were 11% and 18%, respectively. The study showed no significant prolongation of survival, progression-free survival, or differences in patterns of failure in irradiated patients treated with levamisole compared with a placebo. Toxicity related to this immunoadjuvant was, in general, of moderate clinical importance. This study confirms a report by the Southeastern Cancer Study Group concluding that levamisole combined with definitive irradiation has no benefit in the treatment of unresectable non-small cell carcinoma of the lung.

Adenocarcinoma↗

Hyperthermia in combination with definitive radiation therapy: results of a Phase I/II RTOG Study.

Between August 1981 and April 1986, 133 patients with superficial malignant tumors not previously treated with radiotherapy were entered on a Phase I/II RTOG study evaluating hyperthermia plus definitive radiotherapy. Eligible patients included those with superficial epithelial or mesenchymal tumors less than 4 cm in depth. Protocol radiotherapy specified a tumor dose of 60 Gy delivered in 1.8-2.0 Gy fractions 5 times/week with a boost of 5-10 Gy through reduced portals to residual tumor. Protocol hyperthermia, delivered twice weekly, was to start within 15 minutes following irradiation and to consist of 60 minutes of heat to a tumor temperature of 43 degrees C. Sixteen patients were excluded. Of the 117 eligible patients, the treated lesions had site/histologies which were 35% head & neck/squamous, 46% breast/adenocarcinoma, and 19% other site/histologies. Lesions were 3 cm or larger for 77% of patients. Of the 41 patients with head & neck/squamous lesions, skin or subcutaneous necrosis occurred within 6 months for 2% of the patients; 12% experienced thermal blisters. Fourteen patients were followed for 6 months or more following start of treatment; none of these experienced late toxicities more severe than telangiectasis. Complete responses were observed in 51% of these patients. Of the 54 patients with breast/adenocarcinoma lesions, skin or subcutaneous necrosis occurred within 6 months for 13% of the patients; 17% experienced thermal blisters. Thirty-seven patients were followed for 6 months or more following start of treatment; complications observed during this period included 13% with ulceration and one case of skin necrosis. Complete responses were observed in 85% of these patients. Local control was maintained at nearly this level for at least 2 years. Logistic regression analyses showed site/histology, greatest tumor diameter and average tumor temperature to be significantly related to response. Based on these promising findings, the RTOG has instituted a randomized Phase III study evaluating radiation therapy with or without hyperthermia in this patient population.

Adenocarcinoma↗

Renal failure following cardiac surgery in a 2.8-kg infant managed with continuous arteriovenous hemofiltration.

Renal failure occurred after repair of transposition of the great vessels with ventricular septal defect in a 2.8-kg infant and was managed successfully with continuous arteriovenous hemofiltration. The infant lost the weight that had been gained as extravascular water, thereby simplifying her fluid, electrolyte, and nutritional management. She ultimately died of cardiac failure.

Acute Kidney Injury↗

Chondral lesions of the femoral condyles: a system of arthroscopic classification.

Based on a study of 167 chondral lesions in 140 knees, six different types of lesions confined to the articular cartilage of the femoral condyles are recognized. They are: type I, linear crack; type II, stellate fracture; type III, flap; type IV, crater; type V, fibrillated; and type VI, degrading. The weight-bearing parts of the surfaces are the site of predilection in most cases. The mechanism behind the injuries is discussed, with types I-IV probably of acute traumatic origin, and types V and VI associated with degenerative processes.

Adult↗

[Magnetic resonance tomographic studies of paragangliomas of the glomus caroticum and glomus jugulare using Gd-DTPA].

The value of magnetic resonance tomography in the diagnosis of paragangliomas in the head and neck has been studied and compared with CT and angiography. Magnetic resonance tomography on its own equals the accuracy of CT, but the use of Gd-DTPA improves diagnostic accuracy. In 19 patients with a glomus jugulare tumour, MR tomography with Gd-DTPA accurately diagnosed all tumours larger than 5 mm. In seven patients with a carotid body tumour, it was possible to arrive at an exact differential diagnosis. Sensitivity was better than that of CT or of sonography. Where there is clinical suspicion of a glomus tumour, magnetic resonance tomography with Gd-DTPA should be the first investigation; if there is a positive finding, angiography should be carried out to demonstrate the circle of Willis.

Carotid Body Tumor↗

Rejection, after a slightly prolonged survival time, of Langerhans cell-free allogeneic cultured epidermis used for wound coverage in humans.

Autologous cultured epidermis (CE) grown from small skin biopsies in vitro has been successfully applied for wound grafting in humans. Since it has been reported recently that allogeneic CE might be tolerated as permanent wound cover, we investigated the properties of CE and its use as autologous and allogeneic grafts. Except for some differences, such as the absence of Langerhans cells and the lack of a stratum corneum, CE resembled its natural analogue. Autologous CE applied for grafting of leg ulcers and various surgical skin defects adhered firmly and permanently to the wound bed within 2 weeks, became regularly stratified, and formed a stratum corneum. Langerhans cells gradually entered the grafts; the dermis contained no inflammatory infiltrate. Allogeneic CE unmatched for MHC and blood group antigens used to partially cover tangentially excised third-degree burns, donor sites of split-thickness skin, and a defect after tumor excision initially survived well like the autografts. However, they were completely rejected after 10-22 (mean, 14.5) days, which is 4-5 days later than reported for split-thickness skin allografts. Clinically, rejection presented as "melting" of the graft. (Immuno)histologically, we found a dense mononuclear dermal infiltrate consisting predominantly of activated T cells, vacuolization, and single-cell necrosis of keratinocytes, as well as HLA-DR expression on keratinocytes, and finally separation and lysis of the epidermis. Limiting dilution analysis in 2 out of 4 allograft recipients revealed a considerable increase of circulating donor-specific cytotoxic T cell precursors during graft rejection. We conclude that grafting of allogeneic CE does not lead to permanent but to slightly prolonged graft survival.

Adolescent↗

Polycel-bone composite drum-to-footplate columella.

A composite drum-to-footplate columella has been described. The lateral part of this columella is made of cortical bone, which is well-tolerated by the tympanic membrane. The medial part is a Polycel cylinder that contains a central wire core that is not supposed to experience atrophy. The connection is brought about by insertion of the cylinder into a hole drilled into the bony part. Eighteen columellas have been used in staged surgery. Check-up time varies between 3 months and 2 years. Average improvement in air conduction was 19.6 dB; average postoperative air-postoperative bone gap was 19.7 dB. There have been no extrusions so far.

Adult↗

Variable expressivity of neurofibromatosis-1 in identical twins.

Monozygotic twins with Neurofibromatosis-1 (NF-1) who have both concordant and discrepant clinical manifestations are reported. At 7 years of age, both twins were found to have learning disabilities, poor fine and gross motor skills, but different distributions of café-au-lait spots, axillary freckling, and iris Lisch nodules; only twin A was found to have multiple neurofibromas involving the mesentery. Manifestations of mesenteric neurofibromas have not been reported previously to occur this early in childhood; they are an unusual presenting feature of NF-1.

Child↗

[Current status of radiotherapy following ablative and breast-sparing treatment of breast cancer].

After a total mastectomy in cases of a high risk of loco-regional recurrence the postoperative irradiation of the chest wall is indicated in the following situations: Inflammatory type of carcinoma, tumor stage T3-T4, extended multifocal and multicentric primary tumor. After radical axillary surgery even in patients with positive nodes irradiation is not necessary except in cases where all axillary nodes are involved or with invasion of the axillary tissue. The supra- and infraclavicular lymph drainage regions caudal to the operated area (clip) should be irradiated with 50 Gy providing both an enlarged or subtotal involvement can be diagnosed. The irradiation of the retrosternal lymph-drainage system with 45-50 Gy is indicated as follows: Medial or central tumor site, extensive involvement of the axillary nodes and advanced stages of the primary tumor (T2-T4). Axillary irradiation alone cannot serve as a substitute for surgery. After segmental mastectomy without postoperative radiotherapy a local failure rate of 30% is to be expected during a 5 year period. After surgery with adjuvant postoperative irradiation the local failure rate can be reduced to about 5%: 50-60 Gy should be applied. In case of an unfavourable histology an additional boost dose is recommended. The objective of breast cancer irradiation is to achieve freedom of loco-regional recurrence. The survival can be improved occasionally after local irradiation, theoretically improvement of survival can be achieved in 7-10% at the most.

Breast Neoplasms↗

[Mass mammography screening. A means of reducing mortality in breast cancer?].

The already high and still rising mortality rate for breast carcinoma continues to represent a serious problem, especially since neither surgical treatment nor radiotherapy has a significant influence on the prognosis of the disease. Mammography has made it possible to diagnose small and minute carcinomas of the breast before they become clinically symptomatic. Lymph node involvement is histologically confirmed in approximately 20% of breast carcinomas detected by mammography, as opposed to roughly 50% of the tumors diagnosed clinically. Further, in randomized studies mammoscreening was shown to reduce the mortality rates by 30% to 40%. Mammoscreening thus appears to be the only means of diminishing the mortality rate for breast carcinoma.

Breast Neoplasms↗

[Breast-sparing therapy of breast cancer: on the combination of radiation therapy with adjuvant chemotherapy].

From January, 1975 through June, 1986, 426 patients with mammary carcinomas were submitted to primary, breast-preserving therapy at the Gynecological Hospital of the University of Heidelberg. 212 women with a minimum observation time of twelve months fulfilled the criteria of a "typical" treatment: tumor size up to 3 cm, segment/quadrant resection and axillary lymphonodectomy with at least eight lymph nodes removed, radiotherapy of the residual breast with greater than or equal to 45 Gy, in case of histological lymph node manifestation adjuvant hormonal and/or chemotherapy. The average observation time was 38 months, the medium age 48 years. Patients with histological lymph node manifestations were compared with a matched control group of women treated treated by modified radical therapy. According to the error estimation of Kaplan and Meier (1958), no differences were found for local recurrence rate, disease-free survival, and overall survival. Patients treated by organ-preserving therapy with adjuvant chemotherapy were opposed to a matched control group of women treated only by surgical/radiological, organ-preserving therapy. In patients with chemotherapy, the incidence of cutaneous erythema (29% versus 24%), telangiectasia (34% versus 24%), hyperpigmentation (41% versus 34%) showed an upward tendency, but was not significantly increased. There was no difference in the incidence of clinically palpable fibroses (37% versus 42%) and fibroses shown by mammography (54% versus 51%). The frequency of pneumonitis/fibrosis of the retromammary lung area (22% versus 10%) after chemotherapy was two times higher than in the matched control group not treated by chemotherapy.

Antineoplastic Agents↗

[Pharmacokinetics and pharmacodynamics of theophylline in geriatric patients with multiple diseases].

The pharmacokinetics of theophylline (200 mg i.v.) were determined in 20 geriatric patients with multiple diseases. Serum concentrations were fitted to an open 2-compartment model. Percent changes in venous pCO2 and pO2 were used as parameters of the pharmacodynamic action. Total clearance was decreased and elimination half-life of theophylline was found to be prolonged in the elderly patients compared with data of a study with young healthy volunteers. The stronger the pharmacodynamic action of theophylline (percent change of venous pCO2 after 30 min), the faster was its elimination and the lower were measured concentrations after 2, 6, and 12 h.

Age Factors↗