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Biomedical subjects

M David

Publications and source records attributed to M David.

At least 37 records · Page 2Linked to original sources
PubMed2005

[Analysis of the static pressure volume curve of the lung in experimentally induced pulmonary damage by CT-densitometry].

PURPOSE: To study quantitative changes of lung density distributions when recording in- and expiratory static pressure-volume curves by single slice computed tomography (CT). MATERIALS AND METHODS: Static in- and expiratory pressure volume curves (0 to 1000 ml, increments of 100 ml) were obtained in random order in 10 pigs after induction of lung damage by saline lavage. Simultaneously, CT acquisitions (slice thickness 1 mm, temporal increment 2 s) were performed in a single slice (3 cm below the carina). In each CT image lung segmentation and planimetry of defined density ranges were achieved. The lung density ranges were defined as: hyperinflated (-1024 to -910 HU), normal aerated (-910 to -600 HU), poorly aerated (-600 to -300 HU), and non aerated (-300 to 200 HU) lung. Fractional areas of defined density ranges in percentage of total lung area were compared to recorded volume increments and airway pressures (atmospheric pressure, lower inflection point (LIP), LIP*0.5, LIP*1.5, peak airway pressure) of in- and expiratory pressure-volume curves. RESULTS: Quantitative analysis of defined density ranges showed no differences between in- and expiratory pressure-volume curves. The amount of poorly aerated lung decreased and normal aerated lung increased constantly when airway pressure and volume were increased during inspiratory pressure-volume curves and vice versa during expiratory pressure-volume loops. CONCLUSION: Recruitment and derecruitment of lung atelectasis during registration of static in- and expiratory pressure-volume loops occurred constantly, but not in a stepwise manner. CT was shown to be an appropriate method to analyse these recruitment process.

Absorptiometry, Photon↗
PubMed2005

Topical capsaicin for the treatment of acute lipodermatosclerosis and lobular panniculitis.

Topical capsaicin is well known to reduce nociceptive pain and neurogenic inflammation by depleting substance P. Its fibrinolytic and antithrombotic effects are less well known. We report two cases of acute lipodermatosclerosis which did not respond to several conventional treatment regimens and one case of acute lobular panniculitis in a pregnant woman with venous insufficiency, who were successfully treated within a short period of 3 weeks with topical 0.075% capsaicin cream.

Acute Disease↗
PubMed2005

In vitro cytokine profile in childhood alopecia areata and the immunomodulatory effects of AS-101.

The aim of the present study was to determine the effect of AS-101, a known immunomodulator, on the pattern of cytokine production in children with patchy alopecia areata (PAA). Ten previously untreated children with PAA were compared to 10 healthy age- and sex-matched controls. Peripheral blood mononuclear cells (PBMC) were isolated from all participants. Unstimulated and phytohaemagglutinin (PHA)-stimulated PBMC were tested with and without the addition of AS-101. The production of interferon gamma (IFNgamma), soluble interleukin (IL)-2 receptor (IL-2R), IL-10, IL-5 and IL-6 was determined. The levels of soluble IL-2R, IL-5 and IL-6 were significantly higher in the PAA patients than the controls. AS-101 inhibited the production of IL-10, IFNgamma, IL-2R and IL-5 in both PAA patients and controls, but there was a greater inhibitory effect in children with PAA.

Adolescent↗
PubMed2005

Protective effect of intravenous immunoglobulin (IVIG) in an experimental model of pemphigus vulgaris.

Uncontrolled studies have found intravenous immunoglobulin (IVIG) to be effective in the treatment of pemphigus vulgaris (PV). The aim of this study was to evaluate the role of IVIG in preventing IgG autoantibodies binding to desmoglein-3 and blister formation using a controlled experimental design. The ability of IVIG to affect the binding of IgG affinity purified from two patients with PV to desmoglein-3 in comparison to IgG from one donor, was conducted by enzyme-linked immunosorbent assay (ELISA). The specificity was confirmed by competition assay. We assessed the effect of IVIG on the induction of experimental-PV in CD1 newborn mice by subcutaneous subjection of IgG affinity purified from two patients with PV. The treatment was conducted by subcutaneous administration of IVIG together with IgG from the pemphigus patients or appropriate control. The skin of the newborns was examined 24-48 h later for blisters, and samples of the affected areas were analysed by immunohistochemistry. IVIG as a whole molecule and its F(ab)(2) portion inhibited the binding of anti-desmoglein-3 antibody to recombinant desmoglein-3 in a dose-dependent manner. The specificity was confirmed by competition assays. In-vivo, IVIG and its F(ab)(2) portion prevented blister formation in the newborn mice. Cutaneous lesions were noted only in the groups of newborn mice who were injected with IgG fractions from the PV patients. Immunopathological evaluation revealed that IVIG prevented the formation of acanthylosis with IgG deposition in the intercellular spaces. These results point to the efficacy of IVIG in the prevention of blister formation in an experimental PV model.

Animals↗
PubMed2005

High-frequency oscillatory ventilation in adults with traumatic brain injury and acute respiratory distress syndrome.

BACKGROUND: This study observed adverse events of rescue treatment with high-frequency oscillatory ventilation (HFOV) in head-injured patients with acute respiratory distress syndrome (ARDS). METHODS: Data of five male patients with ARDS and traumatic brain injury, median age 28 years, who failed to respond to conventional pressure-controlled ventilation (PCV) were analyzed retrospectively during HFOV. Adjusted mean airway pressure at initiation of HFOV was set to 5 cm H2O above the last measured mean airway pressure during PCV. Frequency of pulmonary air leak, mucus obstruction, tracheal injury, and need of HFOV termination due to increased intracranial pressure, decreased cerebral perfusion pressure, or deterioration in P(a)CO2 were analyzed. RESULTS: During HFOV we found no complications. We recorded 390 datasets of intracranial pressure, cerebral perfusion pressure and P(a)CO2 simultaneously. Intracranial pressure increased (>25 mmHg) in 11 of 390 datasets, cerebral perfusion pressure was reduced (<70 mmHg) in 66 of 390 datasets, and P(a)CO2 variations (<4.7 kPa; >6.0 kPa) were observed in eight of 390 datasets after initiation of HFOV. All these alterations were responsive to treatment. P(a)O2/F(I)O2-ratio improved in four patients during HFOV. CONCLUSION: High-frequency oscillatory ventilation appears to be a promising alternative rescue treatment in head-injured patients with ARDS if continuous monitoring of intracranial pressure, cerebral perfusion pressure and P(a)CO2 are provided, in particular during initiation of HFOV.

Adolescent↗
PubMed2005

Behavioural changes in freshwater fish, Cirrhinus mrigala (Hamilton) exposed to cypermethrin.

The toxicity of insecticide cypermethrin to the freshwater fish, Cirrhinus mrigala was studied using static bioassay method. The 96 h LC50 was found to be 5.13 microg/l. Increase in opercular movement, loss of equilibrium, increase in surface behaviour, change in body colour, increase secretion of mucus, irregular swimming activity, rapid jerk movement, 'S' jerky, partial jerk, and aggressiveness were observed in fish exposed to lethal concentration of cypermethrin. But in sub lethal concentration changes were observed from that of lethal and with the approach of 14 and 21 day, fish attained to normalcy.

Animals↗
PubMed2004

High-frequency oscillatory ventilation and an interventional lung assist device to treat hypoxaemia and hypercapnia.

A male patient accidentally aspirated paraffin oil when performing as a fire-eater. Severe acute respiratory distress syndrome (Pa(o(2))/Fi(o(2)) ratio 10.7 kPa) developed within 24 h. Conventional pressure-controlled ventilation (PCV) with high airway pressures and low tidal volumes failed to improve oxygenation. Hypercapnia (Pa(co(2)) 12 kPa) with severe acidosis (pH<7.20) ensued. Treatment with high-frequency oscillatory ventilation (HFOV) and a higher adjusted airway pressure (35 cm H(2)O) improved the Pa(o(2))/Fi(o(2)) ratio within 1 h from 10.7 to 22.9 kPa, but the hypercapnia and acidosis continued. Stepwise reduction of the mean airway pressure (26 cm H(2)O), and oscillating frequencies (3.5 Hz), as well as increasing the oscillating amplitudes (95 cm H(2)O) resulted in an unchanged Pa(co(2)), but oxygenation worsened. The new pumpless extracorporeal interventional lung assist device (ILA, NovaLung, Hechingen, Germany) was therefore used for carbon dioxide elimination to enable a less aggressive ventilation strategy. Pa(co(2)) normalized after initiation of ILA. HFOV with a mean airway pressure of 32 cm H(2)O was maintained, but with a higher oscillatory frequency (9 Hz) and very low oscillatory amplitude (25 cm H(2)O). After 6 days, the patient was transferred to a conventional ventilator, and ILA was discontinued after 13 days without complications.

Adult↗
PubMed2004

[Magnetic resonance tomography guided focussed ultrasound surgery (MRgFUS) in tumor therapy--a new noninvasive therapy option].

The demand for minimal or non-invasive therapies especially in tumor therapy is increasing constantly. High frequency focussed ultrasound represents an effective and safe alternative to established thermoablative procedures. In this article we report the advantages of MR-guidance for focussed ultrasound. We describe first clinical experiences in the treatment of uterine fibroids, breast cancer and fibroadenomas of the breast employing MR-guided focussed ultrasound surgery (MRgFUS). This method offers strong potential in the treatment also of other tumorentities since it provides excellent accuracy. Currently numerous efforts are undertaken to introduce MRgFUS for the therapy of liver or cerebral tumors.

Breast Neoplasms↗
PubMed2004

Alpha-fetoprotein in the early neonatal period--a large study and review of the literature.

BACKGROUND: Alpha-fetoprotein (AFP) is a glycoprotein molecule, which has similarity to albumin and is produced by the fetal liver. Its biological role is unclear and factors that may influence its concentrations in neonates are only partially identified. However, it has an important role as a diagnostic marker, especially in certain tumors and liver diseases of childhood. Its normal reference values in newborns have not been well defined. METHODS: Serum AFP concentrations were measured and characterized in 260 term and near-term newborns [gestational age (GA)> or =34 weeks, birthweight (BW)> or =1700 g] at birth [umbilical cord (UC) blood] and upon discharge from the nursery at 60+/-24 h of life (venous sample). RESULTS: Due to the nonnormal distribution of AFP levels, it is useful to relate to reference interval for AFP concentrations at birth that was 15.7-146.5 microg/ml, based on 95% confidence interval (CI). The median value of 48.3 microg/ml is also a useful reference. However, mean AFP concentrations at birth that were 61.6+/-44.8 microg/ml are less informative due to the large standard deviation (S.D.). Upon discharge, AFP concentrations dropped to 9.7-111.9 microg/ml (95% CI) with a median of 34.2 microg/ml. A significant negative correlation was found between AFP serum levels and gestational age and to a lesser extent with birthweight. No significant differences were found between males and females. CONCLUSIONS: Normal reference intervals for AFP in term and near-term newborns have been defined, but need to be addressed with caution due to the wide range of normal values. AFP levels at birth decrease as gestation advances and the newborn weighs more.

Adult↗
PubMed2004

Response of Cyprinus carpio (Linn) to sublethal concentration of cypermethrin: alterations in protein metabolic profiles.

Freshwater fish, Cyprinus carpio were exposed to sublethal concentration (1.2 microg l(-1)) of cypermethrin for 6, 12, 24 and 48 h to analyze various parameters of protein metabolism in functionally different tissues. Total, structural and soluble proteins showed decrement; where as free amino acids and the activities of protease, aspartate aminotransferase and alanine aminotransferase significantly increased in cypermethrin exposed fish. Interestingly, ammonia content decreased but urea and glutamine increased at all periods of exposure. It was also observed that alterations steadily increased with the period of exposure and exhibited tissue specificity. Thus variation in the protein metabolism of the fish exposed to cypermethrin indicates its toxic effect on the cellular metabolism thereby leading to impaired protein synthetic machinery.

Alanine Transaminase↗
PubMed2004

Cardiac function and haemodynamics during transition to high-frequency oscillatory ventilation.

BACKGROUND AND OBJECTIVE: This prospective observational study analyses cardiovascular changes in adult patients with acute respiratory distress syndrome (ARDS) during transition from pressure-controlled ventilation to high-frequency oscillatory ventilation (HFOV), using transoesophageal echocardiography (TOE) and invasive haemodynamic monitoring. METHODS: Nine patients (median age 65 years; range 42-70) with ARDS were studied. HFOV was started and maintained with an adjusted mean airway pressure of 5 cmH2O above the last measured mean airway pressure during pressure-controlled ventilation. Haemodynamic and TOE measurements were performed in end-expiration during baseline pressure-controlled ventilation, and again 5 and 30 min after the start of during uninterrupted HFOV. RESULTS: Right atrial pressure increased immediately (P = 0.004). After 30 min, pulmonary arterial occlusion pressure increased (P = 0.008), cardiac index decreased (P = 0.01), stroke volume index decreased (P = 0.02) and both left ventricular end-diastolic and end-systolic area indices decreased (P = 0.02). Fractional area change, left ventricular end-systolic wall stress, heart rate, mean arterial pressure and mean pulmonary artery pressure remained unchanged. CONCLUSIONS: Transition to HFOV at a mean airway pressure of 5 cmH2O above that during pressure-controlled ventilation induced significant, but clinically minor, haemodynamic effects, which are most probably due to airway pressure-related preload reduction.

Adult↗
PubMed2004

Acute moderate hyponatraemia and its rapid correction: effects on striatal and pontine ultrastructure in an animal model of the TURP syndrome.

BACKGROUND AND OBJECTIVE: To investigate the effects of moderate hyponatraemia, induced by intravenous application of an electrolyte-free irrigation fluid, as a model of the human transurethral prostate resection syndrome and of its rapid correction by hypertonic saline infusion in rats. METHODS: Experimental animals received irrigation fluid (Purisole SM) 20 mL kg(-1) body weight, intravenously. In one group, hyponatraemia was subsequently rapidly corrected by infusion of hypertonic saline (NaCl 5.85%), while rats of group two were 'sham-corrected' by infusion of a balanced salt crystalloid solution. Plasma sodium concentrations were analysed during and at the end of the experiments. After 10 days, experimental and untreated control animals were killed humanely, fixed by perfusion and the brains were prepared for electron microscopic investigation of myelin sheets and glial cell numbers in the striatum and pons. RESULTS: The myelin appearance was unaltered in experimental groups compared to controls, but glial cell numbers were distinctly altered in the pons but not in the striatum. In the pons, oligodendrocytes were significantly reduced in number upon rapid correction of hyponatraemia, while astrocyte numbers were increased in rats with uncorrected hyponatraemia. CONCLUSIONS: Our electron microscopic data demonstrate that the effects of hyponatraemia and of its rapid correction are multifarious in animals. This may also apply for human patients during transurethral prostate resection.

Animals↗
PubMed2004

Results of an unrelated transplant search strategy using partially HLA-mismatched cord blood as an immediate alternative to HLA-matched bone marrow.

Cord blood (CB) is an alternative to other sources of stem cells for transplantation. However, the impact of including CB in the initial strategy of unrelated graft search in a cohort of patients has been the object of limited analysis. Here, we report the results of such a strategy in 91 consecutive children. Absence of mismatch was required for adult donors, and up to two mismatches were allowed for CB grafts, with a nucleated cell dose over 2.5 x 10(7) cells/kg. A graft was found for 84 of the 85 children who remained available for a 3-month search. In all, 64 patients were transplanted, 36 with CB and 28 with bone marrow (BM). Primary graft failure, acute grade II-IV and extensive chronic graft-versus-host disease occurred in five, five and zero CB, and in three, one and two BM patients, respectively. The 3-year survival was 59% in CB and 57% in BM patients. Accepting CB as a source of stem cells offers a graft to almost every child in need of an unrelated transplantation, with a probability of survival similar to that of unrelated BM transplantation.

Adult↗
PubMed2004

Antileukemic and long-term effects of two regimens with or without TBI in allogeneic bone marrow transplantation for childhood acute lymphoblastic leukemia.

Between September 1986 and June 1997, 24 children with high-risk ALL in CR1 were allografted after TAM (fractionated TBI, high-dose Ara-C, and melphalan; n = 10) or BAM protocol (busulfan, high-dose Ara-C, and melphalan; n = 14). The EFS for transplants from sibling donors was 33% with TAM and 62% with BAM (P = 0.148). The probability of acute GvHD was 70% with TAM and 15% with BAM (P = 0.003). Four of 17 evaluable patients relapsed: one after TAM and three after BAM. In all, 46 other children transplanted in CR beyond CR1 were studied for sequelae. Long-term side effects were more frequent in TAM vs BAM. In children with ALL, busulfan may be a good alternative to TBI to improve the quality of life.

Adolescent↗
PubMed2004

[Pain and ethnicity - results of a survey at three internal/gynecological first-aid stations in Berlin].

QUESTION: How high is the pain pressure in everyday life of German vs. not German patients, with which troubles do they come to the emergency room, how intense is their pain, how long is it lasting, how many pain areas are named? GROUP OF PATIENTS/METHODS: The study "Utilization of clinical emergency rooms by German patients and migrants" was carried out at first-aid stations of three Berlin hospitals in municipal districts with a high share of foreigners in the population in the form of standardized interviews on following topics: roads to have access to the emergency room, perception and interpretation of pain/troubles, expectations from the first-aid station, further medical care, chronical diseases, self-help measures, social data, migration aspects. RESULTS: An everyday life pressure because of headache and rheumatic pains was named significant more often by migrants of Turkish extraction than by the German women asked. In the age-group 50-65 years the migrants chose significant higher scale values to characterize their pain intensity. Migrants named all in all clearly more pain areas than German patients. The share of patients with pain persisting more than three days was 36.1 % in German women, 45.5 % in migrants of Turkish origin, 45.8 % in women of other ethnicity. CONCLUSIONS: Pain interpretation as well as pain expression are socio-culturally conditioned. Differences between migrants and native patients should lead to take more into consideration the concrete life situation and specific strain in the patients' treatment.

Demography↗
PubMed2004

[Birthplace free-standing birth center -- perinatal data in comparison with clinic deliveries in Bavaria and Berlin].

QUESTION: The purpose of this investigation is to find any differences between important maternal and infantile perinatal data from a clinic and a birth center group. Is the perinatal and/or maternal mortality in the birth center group higher? What influence do different socioeconomic factors have on the clinic group? PATIENTS AND METHODS: We have carried out a retrospective comparison of the obstetric parameters from all birth center deliveries in the states Berlin and Bavaria for the years 1999 and 2000 (n = 3,060) and the perinatal data investigations of selected clinical groups of both states (n = 55,875). RESULTS: Objective parameters in both groups regarding week of potation at delivery, parity, age of pregnant women, infantile measures, primi- and multiparae and Apgar scales were comparable. There are significant differences in the delivery mode (spontaneous deliveries: birth centers > clinics; operative deliveries: birth centers < clinics), in blood loss over 1,000 ml (birth centers > clinics), in the episiotomy and perineal tear rate (birth centers < clinics), in the infantile transfer rate to a neonatology unit (birth centers < clinics) and in the frequency of necessary neonatological measures in the neonate (birth centers > clinics). The perinatal and maternal mortality in the groups were similar. Within the clinical group the socioeconomic status and a background of immigration had no significant influence on the perinatal data. CONCLUSION: The retrospective data show that the more "invasive" clinical obstetrics leads to a similar postnatal condition of the neonates in comparison to the birth house group. Further comparative studies over several years are necessary to make statements about the occurrence of rare risks and maternal mortality in the free-standing birth center groups.

Adult↗