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Biomedical subjects

M Heller

Publications and source records attributed to M Heller.

At least 253 records · Page 14Linked to original sources

[Castleman's disease: evaluation of 338 cases].

PURPOSE: To evaluate a large group of patients with Castleman's tumours (Castleman's disease = MC) with regard to age, sex and tumour localisation. PATIENTS AND METHODS: 338 cases of MC were evaluated. All cases were registered by the Lymphknotenregister of the German Society of Pathology, Kiel. RESULTS: 292 MC of the hyaline vascular type (MC-HV) and 46 of the plasma cell type (MC-PC) were found, 259 (76.6%) in nodal and 79 (23.4%) in extranodal localisation. Main nodal localisation were the neck (25.5%) and the axilla (12.8%). The mediastinum was involved in only 6.2%. There was a slight preference of female (56%) compared to male (44%). Patients with MC-PC (mean age: 50 +/- 16.9 years) were significantly older (p < 0.001) than patients with MC-HV (mean age: 39 +/- 18.9 years). CONCLUSIONS: The main localisation of MC is the neck. MC-HV is more common than MC-PC. There is a slight preference for women. Mean age of patients with MC-PC is approximate 10 years higher than for MC-HV.

Adolescent↗

In vivo P-31-MR-spectroscopy of focal hepatic lesions. Effectiveness of tumor detection in clinical practice and experimental studies of surface coil characteristics and localization technique.

RATIONALE AND OBJECTIVES: The influence of partial tumor sampling in a volume of interest (VOI) on the ratios of phosphorus metabolites was examined by localized phosphorus magnetic resonance spectroscopy (P-31-MRS). Experiments were performed to investigate the characteristics of the surface coil used and precession of spatial localization. METHODS: A total of 24 patients with liver metastases and 20 volunteers were studied by P-31-MRS. Patients were divided in two groups: VOI < 50% (n = 8) and VOI > 50% (n = 16) occupied by tumor. For evaluation of the surface coil and localization method (image selected in vivo spectroscopy), phantom studies were performed. RESULTS: Superficial focal liver tumors were detectable with a surface coil at a distance within the coil radius. The image selected in vivo spectroscopy permitted the study of phosphorus metabolism in a defined VOI, phosphomonoester/beta-adenosine triphosphate and phosphodiester/beta-adenosine triphosphate were elevated significantly in spectra of both patient groups. CONCLUSIONS: Detection of small tumor volumes within a VOI filled by less than 50% of the tumor is possible, with results statistically different from that in normal volunteers.

Adult↗

Application of the maximum entropy method for evaluating phosphorus-31-magnetic resonance spectra in patients with liver metastases.

RATIONALE AND OBJECTIVES: The clinical feasibility and application of the maximum entropy method for data analysis from in vivo phosphorus-31-magnetic resonance (P-31-MR) spectra of the liver were determined. METHODS: Image-guided localized P-31-MR spectroscopy was performed in 24 patients with liver metastases and in 20 healthy volunteers. The spectra were obtained with a whole body scanner operating at 1.5 T using a surface coil. Phosphomonoester/beta-adenosine triphosphate (ATP), phosphodiester/beta-ATP, and inorganic phosphate/beta-ATP were calculated from the maximum entropy method-spectra and from spectra evaluated with standard data processing (Fourier transformation spectra). RESULTS: Phosphomonoester/beta-ATP and phosphodiester/beta-ATP were increased significantly with both methods in patients' spectra. Maximum entropy method spectra showed a distinct pattern with low noise. It was easier to determine peak borders and to attach resonances to the different metabolites using this method. CONCLUSIONS: Maximum entropy method is an alternative method for evaluation and quantification of P-31-MR spectra data and is preferred to standard data processing with Fourier transformation in cases of reduced signal-to-noise ratio of spectra.

Aged↗

Theoretical considerations and in vitro results for the development of percutaneous transcatheter balloon embolectomy.

RATIONALE AND OBJECTIVES: To prove the feasibility of performing percutaneous transcatheter embolectomy using a funnel-shaped catheter tip and balloon embolectomy catheters. METHODS: A theoretical model is described to assess the influence of the diameter of an introductory device and coaxially introduced embolectomy catheter. A funnel-shaped catheter tip was attached to 7F, 8F, and 9F introductory sheaths. In vitro embolectomy of 5 g and 12 g thrombi was performed with 3F and 4F embolectomy catheters. RESULTS: The number of extractions required was significantly related to the ratio of the diameters of the sheaths and embolectomy catheter shafts. The combination of a 7F sheath with a 4F embolectomy catheter required the greatest number of extractions (8.4 +/- 1.7). The least number of extractions was needed for the combination of a 9F sheath with 4F and 3F embolectomy catheters (1.6 +/- 0.7 and 1.8 +/- 0.4, respectively). CONCLUSIONS: Our results indicate that percutaneous embolectomy with balloon embolectomy catheters is feasible. However, further research is necessary before the final catheter design is chosen.

Catheterization↗

[Functional MRI of the femoropatellar joint].

Conventional X-ray examinations of the patellofemoral joint in 30 degrees, 60 degrees and 90 degrees of knee flexion demonstrate the position of the patella. On the other hand, they have been shown to be insufficient for the diagnosis of patellofemoral maltracking in the critical range between 30 degrees of flexion and full extension. Motion-triggered and ultrafast MRI offer new possibilities for functional diagnosis of the patello-femoral joint under active knee motion. Functional MRI of the patellofemoral joint is suggested as an alternative to arthroscopy, particularly in patients with anterior knee pain or suspected patellar maltracking.

Arthroscopy↗

[Spiral CT of the thorax with double table feed in relation to slice thickness].

PURPOSE: The aim of the study was to reduce investigation time, radiation dose, and contrast material when performing spiral-CT of the thorax. METHODS: 50 patients with different clinical diagnoses underwent spiral-CT of the thorax with double table feed and 45 ml contrast material (lopentol) were injected. Density measurements were performed as follows: main pulmonary artery without contrast injection, carotid artery, subclavian artery, ascending and descending aorta, aortic arch, main pulmonary artery and thoracic aorta after contrast injection. RESULTS: In comparison to the density of the main pulmonary artery without contrast injection there was an increase of density of 134 HU. 45 ml of the contrast agent were sufficient in all cases for delineation of the mediastinal vessels. Investigation time was 16-18 s and all patients were able to hold their breath during this time, so no artifacts were seen. Radiation dose was cut in half. CONCLUSION: Spiral-CT with double table feed enables investigations of the thorax in less than 20s. 45 ml of a contrast agent are sufficient for performing this examination. There are no essential diagnostic deficits with this technique.

Absorptiometry, Photon↗

[An alternative to immunofluorescence on frozen tissue for the diagnosis of sub-epidermal auto-immune bullous dermatosis].

The diagnosis of subepidermal auto-immune bullous dermatosis is usually based on immunofluorescence which demonstrates IgA, IgG, IgM or C3 on dermo-epidermal junction. However in some instance, this technique could not be performed. Here we report an alternative to immunofluorescence. It is a preembedding technique of immunolabelling using horseradish peroxidase, on fresh tissue without any freezing, before an inclusion in wax. So the observation of the labelling is possible with a standard microscope. This technique has been applied to 7 patients with various sub-epidermal auto-immune bullous dermatosis whose diagnosis was confirmed elsewhere by immunoelectron microscopy. It was as specific and sensitive than immunofluorescence whatever the bullous dermatosis.

Autoimmune Diseases↗

Generation by limited proteolysis of a catalytically active 39-kDa protein from the 115-kDa form of phosphatidylinositol-glycan-specific phospholipase D from bovine serum.

It has been suggested previously that small amounts of the mature 115-kDa form of phosphatidylinositol (PtdIns)-glycan-specific phospholipase D from bovine serum may exist as a 47-kDa form which can also be generated in vitro by treatment with proteases. In this study, we investigated the possible proteolytic processing by trypsin of partially purified PtdIns-glycan- specific phospholipase D from bovine serum and found that tryptic digestion caused an apparent activation of the enzyme when assayed in the presence of 0.1% (mass/vol.) Triton X-100. Trypsin cleaved the 115-kDa form of PtdIns-glycan-specific phospholipase D into three major polypeptides with molecular masses of 33, 39, and 47 kDa. Under non-denaturing conditions, the polypeptides remained tightly but noncovalently associated with each other. However, in the presence of 6 M urea, the polypeptides could be separated by anion-exchange chromatography. After renaturation, PtdIns-glycan-specific phospholipase D activity was found to be associated with a 39-kDa fragment. Based on its size and its amino acid sequence, the active-site-containing fragment consisted of approximately 275 residues of the N-terminal region of PtdIns-glycan-specific phospholipase D. The active 39-kDa fragment hydrolyzed the PtdIns-glycan-anchors of solubilized acetylcholinesterase from bovine erythrocytes and variant surface glycoprotein from blood stream trypanosomes. However, this fragment was inactive on membrane-associated acetylcholinesterase and PtdIns.

Amino Acid Sequence↗

Influence of disease manifestation and antineutrophil cytoplasmic antibody titer on the response to pulse cyclophosphamide therapy in patients with Wegener's granulomatosis.

OBJECTIVE: To assess the effectiveness of pulse cyclophosphamide (CYC) in the treatment of Wegener's granulomatosis (WG) and to identify the patients who are responsive to the treatment. METHODS: The prospective study included 43 patients with biopsy-proven WG. Clinical, radiographic, laboratory, and immunologic data were evaluated for predictive values regarding the outcome of pulse CYC therapy. RESULTS: Only 42% of the patients showed complete or partial remission that lasted at least 6 months after cessation of pulse CYC therapy. These responders had a higher frequency of disease activity limited to the upper and lower respiratory tract (39%, versus 8% in the nonresponder group; P < 0.05) and had lower titers of classic antineutrophil cytoplasmic antibody (cANCA) prior to treatment (< 1:64 42%, versus 6% in the nonresponder group; P < 0.05). In the 58% of patients who did not respond to pulse CYC treatment, there was both systemic disease involving more than 4 organ systems (mainly, the heart, nervous system, eye, and skin) and constitutional symptoms. Serious side effects induced by pulse CYC occurred in only 1 patient. CONCLUSION: Based on these findings, pulse CYC therapy appears to be effective in WG patients with moderate disease activity and low titers of cANCA, but of little benefit in patients with severe WG. Pulse CYC should therefore not be used as first-line therapy in patients with severe and rapidly progressing forms of WG associated with high titers of cANCA.

Adolescent↗

Model curriculum for physician training in emergency ultrasonography.

A model curriculum for the implementation and training of physicians in emergency medicine ultrasonography is described. Widespread use of limited bedside ultrasonography by emergency physicians will improve diagnostic accuracy and efficiency, increase the quality of care, and prove to be a cost-effective technique for the practice of emergency medicine.

Curriculum↗

Pancreatic contrast enhancement with Mn-bis pyridoxal ethylene diamine diacetic acid and the influence of a hormonal stimulation of the pancreas in pigs.

RATIONALE AND OBJECTIVES: Pancreatic and hepatic contrast enhancement after different modes of administration of Mn-bis pyridoxal ethylene diamine diacetic acid (Mn-DPDP) and the influence of the hormones secretin and cholecystokinin on the uptake of this new contrast agent were studied by using magnetic resonance (MR) imaging and atomic absorption spectroscopy (AAS) examinations carried out on 13 young domestic pigs. METHODS: Mn-DPDP was administered either as bolus injection or 30-min infusion. The course of contrast enhancement was noted. MR imaging was carried out with or without pancreatic stimulation. The Mn content in pancreatic and hepatic tissue was analyzed by using AAS. RESULTS: Mn-DPDP caused a significant increase (66 +/- 40.1%) in pancreatic signal intensity, an increase in hepatic signal intensity (78 +/- 23.0%), and a significantly higher Mn content on tissue samples of both organs. The results showed a wide individual range. With infusion of Mn-DPDP, pancreatic enhancement was slower, with a peak at 82 +/- 34 min compared with 54 +/- 51 min following bolus injection. The Mn content of both hepatic and pancreatic tissue determined by AAS seemed to be higher after infusion. An incomplete washout of Mn after 24 hr was demonstrated. Hormonal stimulation of the pancreas further increased pancreatic signal intensity but did not influence hepatic contrast enhancement. CONCLUSION: Infusion is the method of choice for administering Mn-DPDP because it causes an increase in hepatic signal intensity but does not change pancreatic enhancement. Although pancreatic hormonal stimulation intensifies enhancement, the increase is not statistically significant, and this practice will not contribute to day-to-day clinical practice.

Animals↗

[High-resolution CT (HRCT) of the lung in Wegener's granulomatosis].

HRCT of the lung and plain chest X-ray were performed to reveal pulmonary manifestation in primary diagnostics or reevaluation of 35 patients with Wegener's granulomatosis. Pleural and parenchymal pathology was detected in chest X-ray of 20 (57%) and in HRCT of 30 (85.7%) patients. Granulomas with and without cavitations and with smooth or spiculated margins were deemed pathognomonic. Nonspecific findings were infiltrates, thickened interlobular septae and fibrotic changes of parenchyma and pleura. Ground glass opacities, traction bronchiectasis and small cysts were only visible on HRCT. As expected HRCT proved to be more sensitive in detecting subtle lung alterations than plain film chest X-ray. It helps to differentiate acute inflammatory and thus potentially curable processes from chronic fibrotic changes in Wegener's granulomatosis.

Adult↗

Antigen heterogeneity among isolates of Mycoplasma bovis is generated by high-frequency variation of diverse membrane surface proteins.

The protein and antigen profiles of 11 isolates of Mycoplasma bovis were compared by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblot analysis of whole organisms. The isolates examined included the type strain PG45 and 10 other filter-cloned strains or purified isolates both from animals without clinical signs and from clinical cases of bovine mastitis, arthritis, or pneumonia. While the overall protein patterns visualized by silver staining were very similar, marked differences in the antigen banding profiles were detected by rabbit antiserum prepared against whole organisms from one of the strains analyzed. This antigenic heterogeneity was shown to be independent of the geographical origin, the type of clinical disease, and the site of isolation and was also observed among serial isolates from a single animal. Antigen profiles were further monitored throughout sequentially subcloned populations of the PG45 strain. This clonal analysis revealed a high-frequency variation in the expression levels of several prominent antigens. All of these variable antigens were defined by detergent-phase fractionation with Triton X-114 as amphiphilic integral membrane proteins. A subset of different-sized membrane proteins was identified by a monoclonal antibody raised against a PG45 subclone expressing a 63- and a 46-kDa variant antigen within that set. The selective susceptibility of these proteins to trypsin treatment of intact organisms and their ability to bind the monoclonal antibody in colony immunoblots demonstrated that they were exposed on the cell surface. In addition, their preferential recognition by serum antibodies from individual cattle with naturally induced M. bovis mastitis or arthritis confirmed that they were major immunogens of this organism. These studies establish that the apparent antigenic heterogeneity among M. bovis isolates reported here does not represent stable phenotypic strain differences generated from accumulated mutational events but reflects distinct expression patterns of diverse, highly variable membrane surface proteins.

Animals↗

A family of phase- and size-variant membrane surface lipoprotein antigens (Vsps) of Mycoplasma bovis.

A set of strain- and size-variant highly immunogenic membrane surface protein antigens of Mycoplasma bovis, which has been identified by a monoclonal antibody, is shown in this report to make up a family of antigenically and structurally related lipid-modified proteins, designated Vsps (variable surface proteins). By systematic analysis of several isogenic clonal lineages of the type strain PG45, three members of this family have been identified, VspA, VspB, and VspC, each of which was shown to undergo independent high-frequency changes in size as well as noncoordinate phase variation between ON and OFF expression states. The monoclonal antibody-defined epitope common to VspA, VspB, and VspC was accessible on the cell surface in most, but not all, of the clonal populations analyzed and was present on a C-terminal limit tryptic fragment of each Vsp variant that was released from the membrane surface. VspA and VspC were distinguished from VspB by their selective detection with colloidal gold and by their distinctive reaction with a polyclonal antibody against M. bovis D490. VspA, VspB, and VspC were further distinguishable from one another by their characteristic patterns of degradation at carboxypeptidase Y pause sites. While these Vsp-specific structural fingerprints with an irregular periodic spacing were constant for similarly sized variants of a defined Vsp product, they showed distinct differences among variants differing in size. This variability included gain or loss of individual bands within distinct subsets of bands, as well as shifts of the entire banding patterns up- or downwards, indicating that insertions or deletions underlying Vsp size variation can occur at various locations either within the C-terminal domain or within other regions of these proteins. This was similarly confirmed by comparative epitope mapping analysis of tryptic cleavage products generated from different Vsp size variants. The Vsp family of M. bovis described in this study represents a newly discovered system of surface antigenic variation in mycoplasmas displaying features which closely resemble but are also different from the characteristics reported for the Vlp (variable lipoprotein) system of M. hyorhinis. The isogenic lineages established here provide key populations for subsequent analysis of corresponding genes to further elucidate Vsp structure and variation, which may have important relevance for a better understanding of the pathogenicity of this agent.

Animals↗

Enhancement of ethanol induced rectal mucosal hyper regeneration with age in F344 rats.

Experimental studies in rats have shown an independent stimulation of rectal cell turnover by either chronic ethanol consumption or age. In this study the combined effect of these two factors on colorectal cell regeneration has been investigated. Ninety male F344 rats aged 2, 12, and 22 months were pair fed nutritionally adequate liquid diets containing 36% of total energy either as ethanol or isoenergetic carbohydrates. After four weeks of feeding, colorectal crypt cell production rates were measured using a stathmokinetic technique with vincristine. While age by itself did not affect colorectal cell renewal, chronic ethanol consumption stimulated rectal, but not colonic crypt cell production rate in an age dependent manner. While no significant effect of ethanol was noted in young animals, cell proliferation was significantly enhanced in middle aged animals by 81% (4.1 (2.7-5.5) v 7.4 (6.0-8.7) cells/crypt/hour, p < 0.001) and in old animals by 138% (4.5 (3.3-5.6) v 10.7 (8.9-12.4) cells/crypt/hour, p < 0.001) after ethanol ingestion. Because acetaldehyde, the first and most toxic metabolite of ethanol, has been detected in the colorectal mucosa and may lead to tissue injury influencing cell regeneration, acetaldehyde concentrations have been measured in the colons of 15 male F344 rats of various ages after an acute intraperitoneal dose of ethanol (2.5 g/kg bodyweight). There was a significant positive correlation between crypt cell production rate and acetaldehyde concentrations measured in the distal and proximal colon after an acute dose of ethanol (r = 0.5955, p < 0.005). These data clearly show that the ethanol mediated stimulation of cell regeneration in the rectum is age dependent. As reported earlier, there was found indirect evidence that acetaldehyde participates in the pathogenesis of rectal hyperregeneration after chronic alcohol consumption. This hyperregeneration of the rectal mucosa after alcohol drinking could by itself favour carcinogenesis, which is especially relevant in old age.

Acetaldehyde↗