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Biomedical subjects

M Wolff

Publications and source records attributed to M Wolff.

At least 181 records · Page 10Linked to original sources
PubMed1995

Short-term effects of methylene blue on hemodynamics and gas exchange in humans with septic shock.

OBJECTIVE: The aim of this study was to investigate the acute effects of methylene blue (MB), an inhibitor of the L-arginine nitric oxide pathway, in patients with septic shock. DESIGN: A prospective, open, single-dose study. SETTING: The medical ICU of a university hospital. PATIENTS: Six patients with severe septic shock. INTERVENTIONS: Complete hemodynamic values were recorded before and 20 min after the infusion of intravenous MB (3 mg kg(-1)). Arterial pressure was then monitored during the next 24 h or until death. MEASUREMENTS AND RESULTS: Methylene blue increased the mean arterial pressure from 69.7 +/- 4.5 to 83.7 +/- 5.1 mmHg (p = 0.028) and the mean pulmonary artery pressure, from 34.3 +/- 7.2 to 38.7 +/- 8.0 mmHg (p = 0.023). Systemic vascular resistance index was increased from 703.1 +/- 120.6 to 903.7 +/- 152.2 dyne.s.cm(-5).m(-2) (p = 0.028) and pulmonary vascular resistance index, from 254.6 +/- 96.9 to 342.2 +/- 118.9 dyne.s.cm(-5) .m(-2) (p = 0.027). The PaO2/FIO2 decreased from 229.2 +/- 54.4 to 162.2 +/- 44.1 mmHg (p = 0.028), without significant modification of intrapulmonary shunting. Heart rate, cardiac index, right atrial pressure, DO2, VO2, oxygen extraction and arterial lactate were essentially unchanged. Sequential measurements of arterial pressure demonstrated a return to baseline level in 2-3 h. All but one patients died, three in shock and two in multiple organ failure. CONCLUSIONS: MB induces systemic and pulmonary vasoconstriction in patients with septic shock, without significant decrease in cardiac index. The worsening of arterial oxygenation following MB injection may limit its use in patients with the adult respiratory distress syndrome. Larger studies are required to determine whether MB improves the outcome of patients with septic shock.

Adult↗
PubMed1995

Pericellular PO2 and O2 consumption in monolayer cell cultures.

The current study was based on the uncertainty as to how well monolayer cell cultures growing in customary polystyrene dishes are supplied with O2. For dishes maintained in an air-5% CO2 atmosphere at 37 degrees C, microelectrode measurements revealed that the pericellular steady-state PO2 was 78 mm Hg in confluent bovine endothelial, 110 mm Hg in rat renal mesangial, and 0 (< 0.2) mm Hg in renal (LLC-PK1 and LLC-MK2) or hepatic (HepG2, Hep3B) epithelial cell cultures. These measured PO2 values were in good agreement with those calculated from Fick's law of gas diffusion, applied for the present culture conditions (one-dimensional O2 diffusion, 0.52 cm medium height), the individual cell layer density and the tissue-specific rate of O2 utilization. Our results provide reasons to speculate that conventional monolayer cultures are often hypoxic when incubated in an air-5% CO2 atmosphere. Diffusion-limitations of cellular O2 availability are to be taken into consideration when tissue cultures are used to study PO2-dependent processes.

Animals↗
PubMed1995

Cytokine therapy for arterial restenosis: inhibition of neointimal hyperplasia by gamma-interferon.

Inhibition of neointimal hyperplasia by gamma-interferon (gIFN) treatment was evaluated. Four groups of Sprague-Dawley rats (n = 72) weighing 500 g underwent endothelial injury of the carotid artery using the previously described Fogarty catheter technique. Group I (controls, n = 8) received one phosphate-buffered saline (PBS) injection 24h before injury and every 24h thereafter for a total of eight injections. Groups II (n = 8) and III (n = 8) received daily injections of 200,000 units of gIFN according to the same schedule except that group III did not receive the preoperative dose. Animals were killed on postoperative day 14. Histologic sections were analyzed morphometrically and immunohistochemically. Both gIFN groups had a statistically significant 50% reduction of the cross-sectional area of the neointimal hyperplasia compared with that of the controls (P < 0.01). Cell replication analysis of smooth muscle cells in the media and neointima revealed no statistically significant difference between controls and gIFN-treated groups. Group IV consisted of 48 rats that were treated with either PBS or gIFN on a schedule similar to that of groups I and II. Animals were killed at frequent time intervals during the first 7 days after injury. Their arteries were analyzed histologically and immunohistochemically. The results confirm previous findings that gIFN reduces the development of neointimal hyperplasia following arterial injury. The results also indicate that smooth muscle cells restore their proliferative activity by 7 days after discontinuation of gIFN treatment. It is proposed that efficacy of gIFN can be enhanced by lengthening the period of treatment.

Animals↗
PubMed1995

Analysis of an international emergency medical service train-the-trainer program.

STUDY OBJECTIVE: To assess the effectiveness of an international emergency medical services (EMS) train-the-trainer program. PARTICIPANTS: Seven bilingual Polish physicians attended a 350-hour US-based EMS training program. The physicians returned to Poland to train Polish-speaking EMS personnel. INTERVENTIONS: The Polish training was assessed by means of a pretest, a final examination, a series of skill stations, and a retrospective self-assessment instrument created by the authors. The retrospective self-assessment instrument, using a six-point Likert scale, measured the degree of self-reported competence before and after training in three areas: basic trauma, advanced medical, and basic medical. RESULTS: One hundred seventy-nine Polish students were assessed. Pretest scores ranged from 17% to 100% (mean, 74% +/- 11%). Ninety-one percent passed the final examination (mean, 91% +/- 4.0%; range, 74% to 99%). All students passed all skill stations. The before-and-after instrument indicated that the Polish students' prior competence ranged from not competent (Likert score 1) to fully competent (Likert score 6). Mean scores were: basic trauma, 2.6 +/- 4; advanced medical, 2.5 +/- 7; and basic medical, 2.8 +/- 7. After-course scores demonstrated improved competence. Before-and-after instrument score differences were significant for each area (P < .0001). CONCLUSION: Despite differences in language, culture, technology, and resources, an international train-the-trainer program can be evaluated. In addition to standard testing, a retrospective before-and-after self-assessment instrument provides corroborative evidence of program success.

Clinical Competence↗
PubMed1995

Identification of blood meals of Phlebotomus perniciosus (Diptera: Psychodidae) in Spain by a competitive enzyme-linked immunosorbent assay biotin/avidin method.

Blood meals from Phlebotomus perniciosus Newstead, collected in four different places in Spain, were identified to determine host-selection patterns. Blood meals were tested using a competitive enzyme-linked immunosorbent assay (ELISA) biotin-avidin method. Results indicate that this species is an opportunist that feeds on those animals to which it has easiest access. However, some preferences were indicated, because the insect never fed on chickens and frequently fed on sheep at sites where both sheep and goats were present. At some sites, the number of sand flies feeding on dogs was higher than expected, based on the proportion of dogs to man. Nevertheless, differences in host behavior, dispersal of engorged sand flies, and their exo- or endophilic habits make it difficult to assign specific host preferences.

Animals↗
PubMed1995

Prosthetic valve endocarditis in the ICU. Prognostic factors of overall survival in a series of 122 cases and consequences for treatment decision.

We carried out univariate and multivariate analysis of outcome among 122 patients with prosthetic valve endocarditis (PVE) admitted to our ICU between 1978 and 1992. The predominant pathogens were Staphylococcus aureus (33%), streptococci (20%), coagulase-negative staphylococci (12%), enterococci (10%), and Gram-negative bacilli (9%). At 4 months, overall survival was 66% (42 deaths). Staphylococcus aureus was the main predictor of death (75% vs 15% with other pathogens). In S aureus PVE, multivariate analysis identified the following predictors of death: prothrombin time < 30% (relative risk [RR]: 8.3), concomitant mediastinitis (RR: 4.9), heart failure (RR: 4.4), and septic shock (RR: 2.6). In PVE due to other pathogens, prothrombin time < 30% (RR: 32.26), renal failure (RR: 7.31), and heart failure (RR: 6.07) were associated with death. In S aureus PVE, survival was higher in patients who received medical-surgical therapy than in those who received medical therapy alone (9/20 [45%] vs 0/20) (p < 0.01). In PVE due to other pathogens, there was no difference in survival between patients who underwent prosthesis replacement (89%) and those who received only medical treatment (81%). Among the 65 patients who underwent heart surgery, the mortality rate and incidence of postoperative paravalvular leakage did not correlate with positive prosthesis cultures. We conclude that non-S aureus and uncomplicated PVE may be managed without valve replacement but that prompt surgical intervention should be required in all other situations.

Adult↗
PubMed1995

Acute lung injury complicating imported Plasmodium falciparum malaria.

STUDY OBJECTIVE: To characterize adult patients with acute lung injury complicating severe imported Plasmodium falciparum malaria. DESIGN AND SETTING: Retrospective study of patients with severe P falciparum malaria admitted to the medical ICU of a university hospital infectious diseases department. PATIENTS: Forty adults with complicated malaria, with (group 1, 12 patients) or without (group 2, 28 patients) acute lung injury. RESULTS: Patients with acute lung injury had a higher simplified acute physiology score on admission (24.2 +/- 3.2 vs 13.7 +/- 0.7 in group 2, p < 0.0001) and a longer time interval to adequate antimalarial therapy (8.8 +/- 2.5 vs 4.9 +/- 0.6 days in group 2, p = 0.046). Of the nine group 1 patients given mechanical ventilation, eight had a PaO2/FIO2 < or = 200 mm Hg. Two patients with moderate hypoxemia received oxygen through a nasal tube and one received continuous positive airway pressure via a face mask. Acute renal failure, unrousable coma, metabolic acidosis, and shock were significantly more common among group 1 patients. The number of complications of malaria was significantly higher in patients with acute lung injury (4.7 +/- 0.5 vs 1.6 +/- 0.1 in group 2, p < 0.0001). Five patients, including four with acute lung injury, had evidence of bacterial infection (pneumonia or primary bacteremia) at ICU admission. Four patients with acute lung injury died (33%) vs one patient without acute lung injury (4%, p = 0.022). CONCLUSIONS: Acute lung injury is more likely to occur in patients with extremely severe, multisystemic P falciparum malaria. In patients with acute lung injury and septic shock, bacterial coinfection should be suspected and treated empirically since it contributes substantially to early mortality.

Acidosis↗
PubMed1995

Overwhelming myocarditis due to Fusarium oxysporum following bone marrow transplantation.

Disseminated infection by Fusarium is being increasingly reported in immunocompromised patients. We report the first case of Fusarium oxysporum disseminated infection with well-documented fungal myocarditis. Despite antifungal therapy and hematologic recovery, the patient died in cardiogenic shock, myocardial involvement clearly contributing to the fatal outcome.

Anemia, Aplastic↗
PubMed1995

[Clinical characteristics and natural history of human immunodeficiency virus infection. Study in a Chilean population served at a multiprofessional pilot center].

Four hundred and eighty six infected adults (90.7% men) were prospectively followed from 1988 to 1993 at a multiprofessional center in Santiago, Chile. 87.8% of male patients (pts)--84% of them homo/bisexual--and 64.4% of women acquired the infection sexually. At the beginning of the follow up (F/U) 51% of men and 71% of women were asymptomatic and 30% of the total group had AIDS. (AIDS definition: CDC 1993, excluded CD4 lymphocyte count < 200 x mm3). 240/486 (49.4%) had developed AIDS at the end of the study (12/31/93). AIDS defining events (ADE) were: interstitial pneumonia (confirmed or suggestive as caused by P. carinii [PCP]), 25%; tuberculosis (all forms), 22.1%; wasting, 13.8%; Kaposi Sarcoma, 9.2%; esophageal candidiasis, 6.7%; isosporiasis, 5.4%. Of all PCP cases, 72% were ADE, the rest, post.AIDS'. As expected, AIDS pts continued having major complications (mainly bacterial pneumonias, PCPs, esophagitis, tuberculosis and diarrhea due to I. belli and Cryptosporidium. Less frequently, but also observed, were toxoplasmic encephalitis and cryptococcal meningitis). Known mortality (excluded abandonment of F/U) was 27% for the whole group and varied from 5.8%, 51.6% to 69.2% for the first, 4th and 6th year of F/U respectively. For II-III CDC pts the mortality was 5% and 57% and for IV CDC pts it was 38% and 100% during the first and 6th year of F/U respectively. 36%, 53%, 74% and 85% of the pts followed for 1, 3, 5 and 6 years respectively had developed AIDS by the end of 1993. Multifactorial causes with either diarrhea, wasting or both were responsible for the death in half the pts in whom this was known, 15% died of respiratory complications and 5.7% of cryptococcal meningitis. 80% of AIDS pts survived their ADE. This study has provided information about the clinical profile of the HIV infection and natural history of the disease in Chile.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Diarrhoeal diseases in the White Mountain Apaches: clinical studies.

Acute diarrhoeal diseases continue to be a major health problem in certain underprivileged populations in the United States, including native Americans living in reservations. To describe the features of patients with diarrhoeal diseases requiring medical care, those attending the medical facilities of the Fort Apache Indian Reservation, Whiteriver, Arizona, were studied during 1981-1985. Clinical and aetiological information was obtained on 535 patients which constitute a 20% sample of those attending the outpatient clinic and all 386 patients who required 550 hospitalizations. Rotavirus, enterotoxigenic Escherichia coli, and Shigella were the most common aetiologic agents, a pattern similar to that seen in the developing countries. The clinical features of diarrhoeal illness and the frequent associated occurrence of acute respiratory symptoms, however, were remarkably similar, regardless of aetiology.

Acute Disease↗
PubMed1995

Diarrhoeal diseases in the White Mountain Apaches: epidemiologic studies.

Acute diarrhoeal disease in children is known to be a major public health problem among native Americans living in reservations in the southwestern part of the United States. This study was undertaken to describe the epidemiology and causative agents of diarrhoea more completely, with the expectation that this information may help in the ultimate control of the disease in this population. Three interrelated epidemiologic studies were carried out in the White Mountain Apache Tribe, Whiteriver, Arizona, during 1981-1985: a three-year longitudinal study on a cohort of 112 newborns, a longitudinal two-year study in a cohort of 200 families, and a case-control study on 1,072 children with diarrhoea attending a medical facility. Both epidemiologic and microbiological patterns of diarrhoeal disease were found to be very similar to those seen in developing countries, indicating the need for basic improvements in sanitation and hygiene in this population.

Acute Disease↗
PubMed1995

[Diagnostic imaging in primary hepatobiliary cystadenoma of the liver].

The clinical and radiological findings of 5 patients with a total of 7 hepatobiliary cystadenomas are reported. In all cases sonography and computed tomography were performed, in three cases angiography was carried out, and in one case magnetic resonance imaging was used. On sonography and computed tomography hepatobiliary cystadenomas exhibit relatively typical findings as a multicystic, space-occupying lesion with septation and papillary mucosal nodes; hence the diagnosis can be made preoperatively in most cases. For differential diagnosis, the malignant form, hepatobiliary cystadenocarcinoma has to be considered which can only be distinguished from the benign form by histology.

Adenoma, Bile Duct↗
PubMed1994

[Cerebro-meningeal infections and immune deficiencies, excluding AIDS].

Infection of the central nervous system is generally a serious event due to the risk of fatality and the possibility of sequelae. In immune deficient patients, there is a relatively large range of infectious agents that may be responsible for meningoencephalitis or a cerebral lesion, and determining aetiology can be difficult. In some cases, the agent is isolated from the CSF or from a peripheral site, which permits rapid, appropriate treatment. In other cases, when a direct neurosurgical approach to the lesions is precluded, the main elements determining the best probable treatment are the nature of the immunodeficiency and especially results of imaging investigation.

Central Nervous System Diseases↗
PubMed1994

Detection of candidemia by polymerase chain reaction.

Current blood culture methods may not identify all patients with candidemia. We attempted to develop a polymerase chain reaction (PCR)-based method for the detection of candidemia. Several major problems were encountered: use of primers based on single copy or low-copy-number genes lacked sensitivity, while those based on the 18S ribosomal RNA gene often crossreacted with human DNA. One primer set with an internal primer was found to be suitable in a hemi-nested PCR. Sensitivity was in the range of 1 colony forming unit of C. albicans per ml blood in reconstruction experiments. Using stored blood which had been obtained within 12 h of the time a positive blood culture was obtained, PCR was positive in 7/15 (46.7%) patients with culture proven C. albicans candidemia (44% of samples). However, only 1-3 ml blood was available for PCR, while culture results were based on 5-10 ml or more. Two out of 34 (5.9%) unselected outpatient blood samples stored under identical conditions were positive, but both samples were negative when the original DNA was retested. Blood collection and PCR processing equipment appears to be free of contaminating fungal DNA and organisms; however, human skin contains DNA amplifiable by these primers. At present the major limitation is the need for a simple method to recover Candida from 5-10 ml blood while removing haemoglobin and excess white blood cell DNA in a volume suitable for PCR.

Base Sequence↗